Molecular Pathology, Oxidative Stress, and Biomarkers in Obstructive Sleep Apnea

Obstructive sleep apnea syndrome (OSAS) is characterized by intermittent hypoxia (IH) during sleep due to recurrent upper airway obstruction. The derived oxidative stress (OS) leads to complications that do not only concern the sleep-wake rhythm but also systemic dysfunctions. The aim of this narrative literature review is to investigate molecular alterations, diagnostic markers, and potential medical therapies for OSAS. We analyzed the literature and synthesized the evidence collected. IH increases oxygen free radicals (ROS) and reduces antioxidant capacities. OS and metabolic alterations lead OSAS patients to undergo endothelial dysfunction, osteoporosis, systemic inflammation, increased cardiovascular risk, pulmonary remodeling, and neurological alterations. We treated molecular alterations known to date as useful for understanding the pathogenetic mechanisms and for their potential application as diagnostic markers. The most promising pharmacological therapies are those based on N-acetylcysteine (NAC), Vitamin C, Leptin, Dronabinol, or Atomoxetine + Oxybutynin, but all require further experimentation. CPAP remains the approved therapy capable of reversing most of the known molecular alterations; future drugs may be useful in treating the remaining dysfunctions.

Automated summary

Obstructive sleep apnea syndrome (OSAS) is a disease characterized by intermittent hypoxia (IH) during sleep due to recurrent upper airway obstruction. The associated oxidative stress (OS) leads to various complications that affect both sleep-wake rhythm and systemic functions. This literature review investigates the molecular changes, diagnostic markers, and potential medical therapies for OSAS. The findings suggest that IH increases oxygen free radicals (ROS) and impairs antioxidant capacities, resulting in endothelial dysfunction, osteoporosis, systemic inflammation, increased cardiovascular risk, pulmonary remodeling, and neurological alterations in OSAS patients. The most promising pharmacological therapies include N-acetylcysteine (NAC), Vitamin C, Leptin, Dronabinol, or Atomoxetine + Oxybutynin, but further research is needed. Continuous positive airway pressure (CPAP) remains the approved therapy for reversing most molecular changes, while future drugs may target the remaining dysfunctions.