Cardiovascular morbidity in obstructive sleep apnea: oxidative stress, inflammation, and much more

Am J Respir Crit Care Med. 2008 Feb 15;177(4):369-75. doi: 10.1164/rccm.200608-1190PP. Epub 2007 Nov 1.


Sleep-disordered breathing and obstructive sleep apnea (OSA) are highly prevalent disorders throughout the lifespan, which may affect up to 2-10% of the population, and have now been firmly associated with an increased risk for cardiovascular and neurobehavioral complications. Nevertheless, the overall pathophysiologic mechanisms mediating end-organ injury in OSA remain undefined, particularly due to the very frequent coexistence of other disease states, such as obesity, that clearly complicate the potential cause-effect relationships. Two major, and to some extent overlapping, mechanisms have been proposed to explain the morbid consequences of OSA, namely increased generation and propagation of reactive oxygen species and initiation and amplification of inflammatory processes. The evidence supporting the validity of these concepts as well as that detracting from such mechanisms will be critically reviewed in the context of clinical and laboratory-based approaches. In addition, some of the contradictory issues raised by such evaluation of the literature will be interpreted in the context of putative modifications of the individual responses to OSA, as determined by genetic variants among susceptibility-related genes, and also by potential environmental modulators of the phenotypic expression of any particular end-organ morbidity associated with OSA.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't
  • Research Support, U.S. Gov't, Non-P.H.S.
  • Review

MeSH terms

  • Cardiovascular Diseases / etiology*
  • Cardiovascular Diseases / physiopathology*
  • Disorders of Excessive Somnolence / complications
  • Disorders of Excessive Somnolence / metabolism
  • Endothelium, Vascular / metabolism
  • Female
  • Humans
  • Hypoxia / metabolism
  • Inflammation / complications
  • Inflammation / physiopathology
  • Male
  • Oxidative Stress
  • Polysomnography
  • Prognosis
  • Reactive Oxygen Species / metabolism
  • Risk Assessment
  • Severity of Illness Index
  • Sleep Apnea, Obstructive / complications*
  • Sleep Apnea, Obstructive / diagnosis


  • Reactive Oxygen Species