Can Obstructive Sleep Apnoea Bring About Reactive Oxygen Species Production?
We all age sometime in our lives. However all of us do not want to age early. However stress, junk food, extra calories, a sedentary lifestyle in front of TVs and computers — all these can bring about oxidative stress. With oxidative stress, there is the production of reactive oxygen species which are chemically reactive molecules containing oxygen. ROS is a biproduct of the normal metabolism of oxygen, however it can increase during stress. ROS can facilitate damage of DNA, oxidations of polyunsaturated fatty acids and of amino acids in proteins and can inactivate some important enzymes and co-factors in the body. If this occurs, the increase in ROS would lead to diseases such as atherosclerosis, heart disease and stroke.
It is not only in stressful situations that we expect an increase in the production of ROS. ROS production can also significantly increase during certain illnesses. An example of those medical conditions which can lead to elevated levels of ROS is obstructive sleep apnoea. Obstructive sleep apnoea is a condition characterised by repetitive pauses of breathing caused by partial or complete collapses of upper airways during sleep. OSA can lead to increased daytime sleepiness, impaired quality of life, arterial hypertension, obesity, and other components of metabolic syndrome as well as coronary artery disease.
It is hypothesised that OSA can indeed elevate ROS levels in the body. This is because pauses of breathing followed by decreased oxygen saturation and arousals during sleep that result in hypoxia/reoxygenation circles. Hypoxia or the lack of oxygen in the body can activate various cells in peripheral blood that leads to increased burst of reactive oxygen species (ROS) which can then initiate the cascade of inflammatory pathways resulting in overexpression of pro-inflammatory cytokines and adhesion molecules. Oxidizing radicals and proteolytic enzymes affect endothelial function during accumulation of leucocytes and platelets on the endothelium and interaction with the vascular wall. This leads to endothelial dysfunction — a subclinical condition of atherosclerosis promoting formation of cardiovascular diseases.
A study published in the May 2013 issue of ScientificWorldJournal tried to test these theories. In this study entitled “Reactive Oxygen Species Production in Peripheral Blood Neutrophils of Obstructive Sleep Apnoea Patients”, forty-six men with OSA and 10 controls were investigated. All subjects were divided into four groups: nonobese mild-to-moderate OSA, obese mild-to-moderate OSA, nonobese severe OSA, and obese severe OSA.
The results showed that neutrophil ROS production is was higher in nonobese severe OSA group compared to nonobese mild-to-moderate OSA. In obese patient groups, ROS production was more increased in severe OSA compared to mild-to-moderate OSA group. Thus the authors concluded that increased neutrophil ROS production was related to more severe OSA but not obesity.
The study showed that obesity itself proved to be an important factor for developing and progression of OSA. Obesity is demonstrated to be a factor of increased oxidative stress as well. The most interesting finding of the study is that increased neutrophil ROS production was related to severity of OSA. Is it possible that ROS levels can worsen sleep apnoea? More studies are still needed to confirm these theories.
Increased ROS production in peripheral blood neutrophils was probably caused by intermittent hypoxia and may have activated inflammatory cascade leading to the development of impaired endothelial function and contribute to the development of cardiovascular diseases. More studies should also be done as to whether CPAP can lower ROS levels as well as treat sleep apnoea.
Reference:
Pilkauskaite G, Miliauskas S, Sakalauskas R. Reactive oxygen species production in peripheral blood neutrophils of obstructive sleep apnoea patients. ScientificWorldJournal. 2013 May 12;2013:421763.
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