Obstructive sleep apnea (OSA) in young patients leads to pathophysiological changes associated with aging. This is evident from study results recently published in the Annals of the American Thoracic Society.
Previous studies have shown that OSA can induce cellular and molecular changes that are linked to the aging process. In addition, these changes may be more significant in younger patients compared to older patients. However, these mechanisms are not well characterized. The aim of this study was to evaluate specific indicators of aging and their association with OSA and to determine whether these changes are consistent in patients in different age groups.
The researchers recruited 599 patients with suspected sleep apnea who were referred to sleep units in 4 hospitals for this multicenter, observational, prospective study. All patients underwent a polysomnographic sleep study. To determine the relationship between the characteristics of aging and OSA, the dose-response relationships of various OSA parameters were examined. The OSA parameters included the apnea-hypopnea index (AHI; defined as the number of apnea and hypopnea events per hour of sleep), the arousal index and the time with an oxygen saturation of less than 90%. In order to investigate the relationship between OSA and aging in different age groups, the patients were divided into 4 groups according to AHI and age (median 50 years).
To investigate the effects of OSA on the aging process, 5 previously identified aging markers were examined: change in cellular communication, measured by C-reactive protein (CRP), deregulation of nutrient measurement, measured by insulin resistance, telomere wear as measured by telomere length, the mitochondrial Dysfunction as measured by leukocyte mitochondrial DNA content and genomic instability as measured by urine concentration of 8-hydroxy-2′-deosxguanosine (8-OHdG).
Of the 599 patients recruited, 150 were classified as “non-OSA” and 449 as OSA. The patients were mainly middle-aged and overweight / obese men. The linear relationship between the severity of OSA and the characteristics of aging was examined. The non-linearity of the relationships was assessed using GAM (Generalized Additive Model) models. There was a relationship between all parameters of OSA and cellular communication, deregulation of nutrient measurement and mitochondrial dysfunction. There was a relationship between AHI and arousal index and genomic instability when the confounding factors were taken into account. There was no association between OSA and telomere wear.
The association between OSA and characteristics of aging was also assessed by age group. In patients under 50 years of age, after adjusting for confounding factors, there was a connection between OSA and changes in intercellular communication, deregulation of nutrient measurements and genomic instability. There was no significant association between OSA and characteristics of aging in the elderly.
The authors recognized several limitations of the study, including the fact that not all age groups were represented equally, onset of OSA was not available, number of patients in each group was not homogeneous, patients studied were referred for OSA and as such may not be generalized to the world population, and not all markers of aging have been studied.
In conclusion, the researchers wrote that their results suggest that early diagnosis and intervention is needed to prevent accelerated aging and its consequences. These results are in line with previous studies linking OSA to aging. However, additional studies are needed to clearly distinguish correlative and causal observations in the possible association between OSA and aging.
Pinilla L., Santamaria-Martos F., Benítez ID, et al .; on behalf of the Spanish Sleep Network. Association of obstructive sleep apnea with the aging process. Ann Am Thorac Soc. Published online March 4, 2021 doi: 10.1513 / AnnalsATS.202007-7710C
This article originally appeared on Pulmonology Advisor