Obstructive sleep apnea (OSA) in young patients results in age-related pathophysiological changes, according to a study recently published in Annals of the American Thoracic Society.
Previous studies have shown that OSA can cause cellular and molecular changes associated with 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 of 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, and prospective study. All patients underwent a polysomnographic sleep study. To determine the relationship between aging characteristics and OSA, the dose-response relationships of different OSA parameters were studied. OSA parameters included apnea and hypopnea index (AHI; defined as the number of apnea and hypopnea events per hour of sleep), arousal index, and time with oxygen saturation less than 90%. To investigate the association of OSA and aging in different age ranges, 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 markers of aging were studied: altered cellular communication measured by C-reactive protein (CRP), nutrient sensitivity deregulation measured by insulin resistance, telomere wear measured by telomere length, mitochondrial dysfunction measured by leukocyte dysfunction. mitochondrial DNA and genomic instability as measured by the concentration of 8-hydroxy-2′-deoxyguanosine in urine (8-OHdG).
Of the 599 recruited patients, 150 were categorized as “persons without OSA” and 449 as OSA. Patients were primarily male, middle-aged, and overweight / obese. The linear relationship between OSA severity and aging characteristics was studied. The nonlinearity of the relationship was estimated using the generalized additive model (GAM) model. There was an association between all OSA parameters and cellular communication, nutrient sensitivity deregulation, and mitochondrial dysfunction. There was an association between AHI and the excitation index and genomic instability when adjusted for confusing factors. There was no association between OSA and telomere wear.
The association between OSA and aging characteristics was also assessed by age group. In patients younger than 50 years, after adjusting for confusing factors, there was an association between OSA and changes in intercellular communication, deregulation of nutrient sensitivity, and genomic instability. There was no significant association between OSA and aging characteristics in elderly patients.
The authors recognized several limitations of the study, including the fact that not all age ranges were equally represented, the onset of OSA was not available, the number of patients in each group was not homogeneous, the patients studied were referred to OSA and as such may not be generalized. for the global population and not all markers of aging have been studied.
In conclusion, the researchers wrote that their findings indicate the need for early diagnosis and intervention to prevent accelerated aging and its consequences. These findings are consistent with previous studies linking OSA to aging. However, additional studies are needed to clearly distinguish correlative and causal observations in the potential association between OSA and aging.
Pinilla L, Santamaria-Martos F, Benitez ID, et al; on behalf of the Spanish sleeping net. Association of obstructive sleep apnea with the aging process. Ann Am Thorac Soc. Published online March 4, 2021 doi: 10.1513 / AnnalsATS.202007-7710C