Cited by 993Obstructive Sleep Apnea ResearchNitric Oxide and Endothelin EffectsAntioxidant Activity and Oxidative Stress

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Obstructive sleep apnoea syndrome – an oxidative stress disorder

Lavie, Lena·2003·Sleep Medicine Reviews

DOI 10.1053/smrv.2002.0261

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Abstract

Obstructive sleep apnoea syndrome (OSA) is associated with increased cardiovascular morbidity and mortality. However, the underlying mechanisms are not entirely understood. This review will summarize the evidence that substantiates the notion that the repeated apnoea-related hypoxic events in OSA, similarly to hypoxia/reperfusion injury, initiate oxidative stress. Thus, affecting energy metabolism, redox-sensitive gene expression, and expression of adhesion molecules. A limited number of studies substantiate this hypothesis directly by demonstrating increased free radical production in OSA leukocytes and increased plasma-lipid peroxidation. A great number of studies, however, support this hypothesis indirectly. Increase in circulating levels of adenosine and urinary uric acid in OSA are implicated with increased production of reactive oxygen species (ROS). Activation of redox-sensitive gene expression is suggested by the increase in some protein products of these genes, including VEGF, erythropoietin, endothelin-1, inflammatory cytokines and adhesion molecules. These implicate the participation of redox-sensitive transcription factors as HIF-1 AP-1 and NFkappaB. Finally, adhesion molecule-dependent increased avidity of OSA monocytes to endothelial cells, combined with diminished NO bioavailability, lead to exaggerated endothelial cell damage and dysfunction. Cumulatively, these processes may exacerbate atherogenic sequelae in OSA.

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Arslan, İ., Aslan, Y., Arı, M., Elli̇dağ, H. Y., & Selçuk, Ö. T. (2026) · Brazilian Journal of Otorhinolaryngology · doi:10.1016/j.bjorl.2026.101856
Chronicity and comorbidities: Is estimated longer duration of obstructive sleep apnoea linked to higher cardiometabolic risk?
Kumar, K. K., Rawat, K., Saini, L. K., Kumar, B., Sridharan, K., Gupta, R., Banerjee, S., Mishra, M., Dua, R., Sharma, P., et al. (2026) · Lung India · doi:10.4103/lungindia.lungindia_888_25
Prevalence of obstructive sleep apnea syndrome in patients with pulmonary embolism: a prospective observational study
Canbaz, M., Uçar, Z. Z., Karasu, İ., Tatar, D., & Erbaycu, A. E. (2026) · Thrombosis Journal · doi:10.1186/s12959-026-00895-0
Association of nasopharynx cancer with obstructive sleep apnea
Huang, Y.-J., Hung, S., Lee, H., Lin, H. C., Chung, S., & Chen, C. (2026) · Frontiers in Oncology · doi:10.3389/fonc.2026.1880900
Sleep-disordered breathing during pregnancy and the risk of postpartum depression
Yakefu, A., Ni, Y.-N., & THOMAS, R. J. (2026) · Sleep Medicine · doi:10.1016/j.sleep.2026.109181
Obstructive sleep apnea severity and morning hypertension in children: Age-stratified associations across developmental stages
Bellary, R., Nair, A., Malavika, P., Naidugari, J., Kahir, J., Orangias, M., El‐Kersh, K., & Senthilvel, E. (2026) · Sleep Medicine · doi:10.1016/j.sleep.2026.109187
Circulating IGFBP-7 in Obstructive Sleep Apnea: A Single-Cohort Preliminary Assessment of Its Diagnostic Performance and Post-Treatment Dynamics
Alterki, A., ALSHAWAF, E. M. M., Alawadh, M., Shamiyah, D. A., Al‐Khairi, I., Cherian, P., Devarajan, S., Ebrahim, M., Alterki, M., Bin‐Hasan, S., et al. (2026) · Biomedicines · doi:10.3390/biomedicines14081780
“Given that oxidative stress, a recognized characteristic of OSA, significantly contributes to cellular senescence, this implies a potential mechanistic link between OSA-induced stress and IGFBP-7 expression [5,32–34].”
Syndrome d'apnée du sommeil en périopératoire
Giraud, A.-H. (2021) · Arnette eBooks · doi:10.3917/arne.lioti.2021.01.0230
Syndrome d'apnée du sommeil en périopératoire
DEFLANDRE, E. P. (2021) · Arnette eBooks · doi:10.3917/arne.lioti.2021.01.0271
Over-hydration as a key modifiable predictor of obstructive sleep apnea severity in dialysis patients with daytime sleepiness
Park, S., Heo, C. M., Park, B. S., Ko, J. H., Park, K. M., Lee, J. G., & Kim, Y. W. (2026) · Medicine · doi:10.1097/md.0000000000050524
“…of OSA with airflow limitation, intermittent hypoxemia, and sleep fragmentation is associated with autonomic nervous system activation, [5] oxidative stress, [6] endothelial dysfunction, [7] and an enhanced inflammatory profile, [8] potentially leading to cardiovascular morbidity and mortality.”
Physical exercise as a modulator of the sleep–obesity interaction: metabolic, neuroendocrine and circadian mechanisms
Campos, R. M. D. S., Souza, H. D. S., Favaron, C. M., Saborosa, G. P., Ferez, L. C., Tufik, S. B., Antunes, H. K. M., D’Almeida, V., & Mônico‐Neto, M. (2026) · Frontiers in Sleep · doi:10.3389/frsle.2026.1943600
“In OSA, repetitive cycles of intermittent hypoxia further amplify ROS generation (Lavie, 2003).”
Association of Changes in Sleep Patterns with Cardiometabolic Disease and All-Cause Mortality: A Prospective Cohort Study among Chinese Adults
Xue, Y., Li, J., Bai, J., Li, X., Liang, Q., He, D., Wang, Z., Zhang, Z., & Zhu, K. (2026) · Heart and Mind · doi:10.4103/hm.hm-d-26-00085
Sleep apnea and night-time hypertension
Schillaci, G., Fiorenzano, G., & Pucci, G. (2015) · Journal of Hypertension · doi:10.1097/hjh.0000000000000676

Authors: Lavie, L.
Affiliations: Technion – Israel Institute of Technology (IL)
Corresponding author: Lavie, Lena
Venue: Sleep Medicine Reviews
Publisher: Elsevier BV
Published: 2003-02
Volume: 7
Issue: 1
Pages: 35-51
ISSN: 1087-0792 (ISSN-L)
DOI: 10.1053/smrv.2002.0261
OpenAlex: W1988114644
Cited by: 993
References: 134
Citations by year: 2026: 17 · 2025: 44 · 2024: 28 · 2023: 30 · 2022: 33 · 2021: 43 · 2020: 42 · 2019: 31 · 2018: 38 · 2017: 37 · 2016: 44 · 2015: 51 · 2014: 58 · 2013: 48 · 2012: 51
FWCI: 4.50
Type: journal article
Language: en
Open access: closed
Licence: www.elsevier.com/tdm/userlicense/1.0/ (tdm)
Locations: Sleep Medicine Reviews (publishedVersion)
PubMed (publishedVersion)
Funders: Ministry of Health, State of Israel
Topics: Health Sciences › Medicine › Physiology (medical) › Obstructive Sleep Apnea Research
Health Sciences › Medicine › Physiology (medical) › Nitric Oxide and Endothelin Effects
Health Sciences › Medicine › Biochemistry (medical) › Antioxidant Activity and Oxidative Stress
Keywords: obstructive sleep apnea, oxidative stress, hypoxia/reoxygenation injury, reactive oxygen species, lipoprotein oxidation, adhesion molecules, adenosine, uric acid, HIF-1, NF-κB, AP-1, endothelial dysfunction, monocyte adhesion, nitric oxide bioavailability, atherosclerosis, cardiovascular risk
MeSH terms: Cardiovascular Diseases, Free Radicals, Humans, Leukocytes, Lymphokines, Nitric Oxide, Lipid Peroxidation, Endothelial Growth Factors, Oxidative Stress, Hyperhomocysteinemia, Sleep Apnea, Obstructive, Intercellular Signaling Peptides and Proteins, Vascular Endothelial Growth Factors, Vascular Endothelial Growth Factor A

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Obstructive sleep apnoea syndrome – an oxidative stress disorder

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