Obstructive sleep apnea and the metabolic syndrome

Obstructive sleep apnea (OSA) and the metabolic syndrome have a strong association with each other owing to their common feature of obesity, but an association independent of obesity has been demonstrated in several studies. There is also evidence, of varying strengths, from epidemiologic and clinical studies, for the independent association between OSA and individual core components of the metabolic syndrome, including hypertension, insulin resistance and dyslipidemia. To date, the data are strongest for hypertension, while data for adverse glucose or lipid metabolism are more controversial. Obesity and other factors, such as alcohol drinking and smoking, obviously pose major confounding hurdles to the clarification of the causal or aggravational role of OSA on cardiometabolic risks. Recurrent episodes of obstructed breathing notably result in intermittent hypoxemia and sleep fragmentation, and these may in turn lead to many adverse body responses, including sympathetic activation, neurohumeral changes and inflammation, which are the seeds for cardiometabolic dysfunctions, such as atherosclerosis and diabetes mellitus. Evidence from translational studies or animal/cell work are forthcoming in the delineation of these pathogenetic mechanisms.