Obstructive Sleep Apnea and Inflammation

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The pathogenesis of cardiovascular complications in obstructive sleep apnea syndrome (OSAS) is not fully understood but is likely multifactorial in origin. Inflammatory processes play an important role in the pathogenesis of atherosclerosis, and circulating levels of several markers of inflammation have been associated with future cardiovascular risk. These include cell adhesion molecules such as intercellular adhesion molecule-1 and selectins, cytokines such as tumour necrosis factor α and interleukin 6, chemokines such as interleukin 8, and C-reactive protein. There is also increasing evidence that inflammatory processes play an important role in the cardiovascular pathophysiology of OSAS and many of the inflammatory markers associated with cardiovascular risk have been reported as elevated in patients with OSAS. Furthermore, animal and cell culture studies have demonstrated preferential activation of inflammatory pathways by intermittent hypoxia, which is an integral feature of OSAS. The precise role of inflammation in the development of cardiovascular disease in OSAS requires further study, particularly the relationship with oxidative stress, metabolic dysfunction, and obesity.

Section snippets

Pathogenesis of Cardiovascular Disease in OSAS

The mechanisms underlying cardiovascular disease in patients with OSAS are still poorly understood. The pathogenesis is likely to be a multifactorial process involving a diverse range of mechanisms including sympathetic nervous system overactivity, selective activation of inflammatory pathways, oxidative stress, vascular endothelial dysfunction, and metabolic dysregulation, the latter particularly involving insulin resistance and disordered lipid metabolism. Although OSAS is associated with a

Inflammation in the Pathogenesis of Cardiovascular Diseases in OSAS

Obstructive sleep apnea syndrome is associated with a variety of features that have been shown to cause pathophysiological responses such as intermittent hypoxia, sleep deprivation and fragmentation, frequent arousals, and frequently associated comorbidities, particularly obesity. This complexity of the disease makes a multifactorial pathogenesis likely. The progress in the understanding of cardiovascular diseases in OSAS is closely linked to the understanding of the development of

Inflammatory Biomarkers in OSAS

Inflammatory biomarkers are increasingly recognized as independent risk indicators for cardiovascular diseases and have also attracted attention in the cardiovascular risk assessment of patients with OSAS. Various reports have assessed circulating levels of inflammatory markers in OSAS with CRP, TNF-α, IL-6, IL-8, and CAMs, alone or in combination, being the most extensively studied.

Conclusion

There is growing evidence that inflammatory cell and molecular mechanisms play an important role in the pathophysiology of cardiovascular disease in patients with OSAS. However, the potential confounding effect of variables such as BMI limits the ability to draw reliable conclusions from some previous studies of this association. Thus, there remains a need for large-scale prospective studies of patient populations with OSAS that are well controlled for important confounding variables such as

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