Obstructive sleep apnoea syndrome – an oxidative stress disorder

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 NFκB. 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.

Keywords: sleep apnoea syndrome, oxidative stress, reactive oxygen species, hypoxia/reoxygenation, adhesion molecules, monocytes, endothelial cells, nCPAP

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• f1 Correspondence should be addressed to: L. Lavie DSc, Anatomy and Cell Biology Unit, The Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, POB 4649, Haifa 31096, Israel. Tel: +972-4-8295234; Fax: +972-4-8295403 or +972-4-8343934; E-mail: lenal@techunix.technion.ac.il