Is obstructive sleep apnea a circadian rhythm disorder?

Mar 15, 2023Journal of sleep research

Is Obstructive Sleep Apnea Related to the Body’s Internal Clock?

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Abstract

Obstructive sleep apnea is the most common sleep-related breathing disorder worldwide, contributing to decreased quality of life and increased mortality.

Obstructive sleep apnea is linked to various comorbidities that affect both health and work performance.
Standard treatments may have limited effects on the cardiovascular and metabolic issues associated with the disorder.
Altered circadian gene expression patterns have been observed in patients with obstructive sleep apnea.
Obstructive respiratory events could disrupt circadian rhythms through sleep disturbances and intermittent hypoxia.
There is a proposed bidirectional relationship between obstructive sleep apnea and circadian rhythm dysregulation.
Further research is necessary before implementing circadian-focused approaches in the clinical management of obstructive sleep apnea.

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Obstructive sleep apnea is the most common sleep-related breathing disorder worldwide and remains underdiagnosed. Its multiple associated comorbidities contribute to a decreased quality of life and work performance as well as an increased risk of death. Standard treatment seems to have limited effects on cardiovascular and metabolic aspects of the disease, emphasising the need for early diagnosis and additional therapeutic approaches. Recent evidence suggests that the dysregulation of circadian rhythms, processes with endogenous rhythmicity that are adjusted to the environment through various cues, is involved in the pathogenesis of comorbidities. In patients with obstructive sleep apnea, altered circadian gene expression patterns have been demonstrated. Obstructive respiratory events may promote circadian dysregulation through the effects of sleep disturbance and intermittent hypoxia, with subsequent inflammation and disruption of neural and hormonal homeostasis. In this review, current knowledge on obstructive sleep apnea, circadian rhythm regulation, and circadian rhythm sleep disorders is summarised. Studies that connect obstructive sleep apnea to circadian rhythm abnormalities are critically evaluated. Furthermore, pathogenetic mechanisms that may underlie this association, most notably hypoxia signalling, are presented. A bidirectional relationship between obstructive sleep apnea and circadian rhythm dysregulation is proposed. Approaching obstructive sleep apnea as a circadian rhythm disorder may prove beneficial for the development of new, personalised diagnostic, therapeutic and prognostic tools. However, further studies are needed before the clinical approach to obstructive sleep apnea includes targeting the circadian system.

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Is obstructive sleep apnea a circadian rhythm disorder?

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