SLEEP-DISORDERED BREATHING DIAGNOSIS AND TREATMENTkapak

THE SYSTEMIC EFFECTS OF OBSTRUCTIVE SLEEP APNEA SYNDROME

Melih Çayönü

University of Health Science, Ankara Bilkent City Hospital, Department of Otorhinolaryngology, Ankara, Türkiye

Çayönü M. The Systemic Effects of Obstructive Sleep Apnea Syndrome. In: Özcan KM, editor. Sleep-Disordered Breathing: Diagnosis and Treatment. 1st ed. Ankara: Türkiye Klinikleri; 2025. p.45-56.

ABSTRACT

Obstructive Sleep Apnea Syndrome (OSAS) is a multifactorial disorder characterised by recurrent upper airway obstruction during sleep, leading to intermittent hypoxia, sleep fragmentation, and sympathetic activation. Beyond its respiratory implications, OSAS exerts widespread systemic effects, contributing to cardiovascular disease, metabolic syndrome, cognitive decline, psychiatric disorders, and gastrointestinal, urogenital, hematological, and immunological dysfunctions. Pathophysiological mechanisms include oxidative stress, chronic inflammation, and hormonal dysregulation. Studies have shown that OSAS is an independent risk factor for the development of cardiovascular disease. Hypertension develops as a result of repeated apneas and hypopneas triggering sympathetic activation. Cardiac arrhythmias, right heart failure, and left heart failure have also been associated with OSAS. Oxidative stress is triggered by hypoxia-reoxygenation cycles. Endothelial dysfunction develops due to increased adhesion molecules and proinflammatory cytokines in endothelial cells. Studies have shown an increased risk of developing coronary artery disease in OSAS patients. OSAS has been shown to affect the metabolic and endocrine systems. It has been found to be strongly associated with metabolic syndrome, insulin resistance, type 2 diabetes mellitus, and dyslipidemia. Neurophysiological studies have shown an increased risk of developing memory impairments, attention deficits, neuropsychiatric symptoms, and stroke in OSAS patients. Excessive daytime sleepiness resulting from sleep fragmentation directly negatively impacts cognitive function. Recurrent hypoxia, increased intra-abdominal pressure, autonomic system disorders, and systemic inflammation also affect the gastrointestinal system. Gastroesophageal reflux and OSAS interact in a bidirectional manner. The liver is also affected by recurrent hypoxia, and fatty liver and fibrosis may occur. OSAS affects the urogenital system, frequently causing decreased libido and erectile dysfunction. Depression is the most frequently reported psychiatric comorbidity. Anxiety disorders and mood disorders are also common psychiatric disorders in OSAS patients. Continuous Positive Airway Pressure (CPAP) therapy remains the cornerstone of treatment and has been shown to reduce systemic inflammation, improve cardiovascular parameters, stabilise metabolic profiles, and alleviate neuropsychiatric symptoms. However, therapeutic efficacy is influenced by adherence and treatment duration. A multidisciplinary approach is essential in managing OSAS-related complications, particularly those involving mood, cognition, and metabolic health. Future directions include personalised therapy, digital adherence monitoring, and biomarker-based evaluation to optimise systemic outcomes in OSAS patients. Large-scale prospective studies are warranted to better understand and mitigate the long-term systemic burden of OSAS.

Keywords: Sleep apnea, obstructive; Arrhythmias, cardiac; Oxidative stress; Metabolic syndrome; Cognition

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