Intermittent Hypoxemia and OSA
Open accessAbstract
OSA is a common chronic disorder that is associated with significant morbidity and mortality including cardiovascular, metabolic, and neurocognitive disease and increased cancer-related deaths. OSA is characterized by recurrent episodes of apneas and hypopneas associated with repetitive episodes of intermittent hypoxemia, intrathoracic pressure changes, and arousals. Intermittent hypoxemia (IH) is now being recognized as a potential major factor contributing to the pathogenesis of OSA-related comorbidities. OSA-related high-frequency IH is characterized by cycles of hypoxemia with reoxygenation that is distinctly different than sustained low-frequency hypoxia and contributes to ischemia-reperfusion injury. Data from both animal and human studies support mechanistic links between IH and its adverse impact at the tissue level. IH promotes oxidative stress by increased production of reactive oxygen species and angiogenesis, increased sympathetic activation with BP elevation, and systemic and vascular inflammation with endothelial dysfunction that contributes to diverse multiorgan chronic morbidity and mortality affecting cardiovascular disease, metabolic dysfunction, cognitive decline, and progression of cancer. Data from observational studies in large population groups also support the role for hypoxia in the pathogenesis of OSA comorbidity. Treatment with CPAP to reverse OSA-related symptoms and comorbidities has been shown to provide variable benefit in some but not all patient groups. Early treatment with CPAP makes intuitive sense to promote maximal functional recovery and minimize residual injury. More studies are needed to determine the interacting effects of IH and obesity, differential effects of both short-term and long-term hypoxemia, and the effect of CPAP treatment.
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The oxygen desaturation index and other variables of oxygen desaturation, such as cumulative time spent below oxygen saturation levels such as 90% (CT90), minimal oxygen saturation, and mean oxygen desaturation, provide important clinical information to better address disease severity and risk of comorbidity in patients with comparable apnea-hypopnea index.
“Furthermore, the ODI and other variables of oxygen desaturation, such as the cumulative time spent below oxygen saturation levels such as 90% (CT90), minimal oxygen saturation, and mean oxygen desaturation also provide important clinical information to better address disease severity and risk of comorbidity in patients with comparable AHI (Dewan et al., 2015).”
From Obstructive sleep apnea: transition from pathophysiology to an integrative disease model (2022) · cites this paper as Dewan et al., 2015
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Experimental — accuracy not yet measuredObesity hypertension is frequently associated with obstructive sleep apnoea, intermittent nocturnal hypoxia and elevated sympathetic nerve activity.
“Obesity hypertension is frequently associated with OSA, intermittent nocturnal hypoxia and elevated SNA174,182.”
From Obesity, kidney dysfunction and hypertension: mechanistic links (2019) · cites this paper as [174]
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“…such as the cumulative time spent below oxygen saturation levels such as 90% (CT90), minimal oxygen saturation, and mean oxygen desaturation also provide important clinical information to better address disease severity and risk of comorbidity in patients with comparable AHI (Dewan et al., 2015).”
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- Authors
- Dewan, N. A., Nieto, F. J., & Somers, V. K.
- Affiliations
- Mayo Clinic (US)
- Creighton University (US)
- University of Wisconsin System (US)
- Corresponding author
- Dewan, Naresh A.
- Venue
- Chest
- Publisher
- Elsevier BV
- Published
- 2015-01
- Volume
- 147
- Issue
- 1
- Pages
- 266-274
- ISSN
- 0012-3692 (ISSN-L)
- PMC
- PMC4285080
- OpenAlex
- W2067956022
- Cited by
- 641
- References
- 89
- Citations by year
- 2026: 42 · 2025: 72 · 2024: 68 · 2023: 68 · 2022: 70 · 2021: 73 · 2020: 69 · 2019: 38 · 2018: 40 · 2017: 40 · 2016: 42 · 2015: 16 · 2014: 2
- FWCI
- 5.64
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- CHEST Journal (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Creighton Digital Repository (CDR) (submittedVersion)
- Funders
- Mayo Foundation for Medical Education and Research
- ResMed
- National Institutes of Health (65176)
- Respicardia
- National Heart, Lung, and Blood Institute (R01HL062252, HL65176, R01HL065176)
- Topics
- Health Sciences › Medicine › Physiology › Obstructive Sleep Apnea Research
- Life Sciences › Neuroscience › Endocrine and Autonomic Systems › Neuroscience of respiration and sleep
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Sleep and related disorders
- Keywords
- intermittent hypoxemia, obstructive sleep apnea, ischemia-reperfusion injury, oxidative stress, reactive oxygen species, angiogenesis, sympathetic activation, hypertension, vascular inflammation, endothelial dysfunction, cardiovascular disease, metabolic dysfunction, cognitive decline, tumor progression, CPAP therapy, obesity
- MeSH terms
- Hypoxia, Cardiovascular Diseases, Chronic Disease, Humans, Risk Factors, Global Health, Comorbidity, Sleep Apnea, Obstructive
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