Oxidative Stress in Obstructive Sleep Apnea Syndrome: Putative Pathways to Hearing System Impairment

Overview

Journal Antioxidants (Basel)

Date 2023 Jul 29

PMID 37507968

Authors

Pierluigi Mastino

Davide Rosati

Giulia de Soccio

Martina Romeo

Daniele Pentangelo

Stefano Venarubea

Marco Fiore

Piero Giuseppe Meliante

Carla Petrella

Christian Barbato

Antonio Minni

Affiliations

Soon will be listed here.

Abstract

Introduction: OSAS is a disease that affects 2% of men and 4% of women of middle age. It is a major health public problem because untreated OSAS could lead to cardiovascular, metabolic, and cerebrovascular complications. The more accepted theory relates to oxidative stress due to intermittent hypoxia, which leads, after an intense inflammatory response through multiple pathways, to endothelial damage. The objective of this study is to demonstrate a correlation between OSAS and hearing loss, the effect of the CPAP on hearing function, and if oxidative stress is also involved in the damaging of the hearing system.

Methods: A review of the literature has been executed. Eight articles have been found, where seven were about the correlation between OSAS and the hearing system, and only one was about the CPAP effects. It is noted that two of the eight articles explored the theory of oxidative stress due to intermittent hypoxia.

Results: All studies showed a significant correlation between OSAS and hearing function ( < 0.05).

Conclusions: Untreated OSAS affects the hearing system at multiple levels. Oxidative stress due to intermittent hypoxia is the main pathogenetic mechanism of damage. CPAP has no effects (positive or negative) on hearing function. More studies are needed, with the evaluation of extended high frequencies, the execution of vocal audiometry in noisy environments, and the evaluation of potential biomarkers due to oxidative stress.

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References

Sadasivam K, Patial K, Vijayan V, Ravi K . Anti-oxidant treatment in obstructive sleep apnoea syndrome. Indian J Chest Dis Allied Sci. 2011; 53(3):153-62. View

Akinnusi M, Jaoude P, Kufel T, El-Solh A . Toll-like receptor activity in patients with obstructive sleep apnea. Sleep Breath. 2012; 17(3):1009-16. DOI: 10.1007/s11325-012-0791-2. View

Kezirian E, Hohenhorst W, de Vries N . Drug-induced sleep endoscopy: the VOTE classification. Eur Arch Otorhinolaryngol. 2011; 268(8):1233-1236. DOI: 10.1007/s00405-011-1633-8. View

Deniz M, Ersozlu T . Evaluation of the changes in the hearing system over the years among patients with OSAS using a CPAP device. Cranio. 2020; 40(6):524-527. DOI: 10.1080/08869634.2020.1783050. View

Patt B, Jarjoura D, Haddad D, Sen C, Roy S, Flavahan N . Endothelial dysfunction in the microcirculation of patients with obstructive sleep apnea. Am J Respir Crit Care Med. 2010; 182(12):1540-5. PMC: 3029939. DOI: 10.1164/rccm.201002-0162OC. View

Grebe M, Eisele H, Weissmann N, Schaefer C, Tillmanns H, Seeger W . Antioxidant vitamin C improves endothelial function in obstructive sleep apnea. Am J Respir Crit Care Med. 2006; 173(8):897-901. DOI: 10.1164/rccm.200508-1223OC. View

Pau M, Zinellu E, Fois S, Piras B, Pintus G, Carru C . Circulating Malondialdehyde Concentrations in Obstructive Sleep Apnea (OSA): A Systematic Review and Meta-Analysis with Meta-Regression. Antioxidants (Basel). 2021; 10(7). PMC: 8300833. DOI: 10.3390/antiox10071053. View

Eisele H, Markart P, Schulz R . Obstructive Sleep Apnea, Oxidative Stress, and Cardiovascular Disease: Evidence from Human Studies. Oxid Med Cell Longev. 2015; 2015:608438. PMC: 4475750. DOI: 10.1155/2015/608438. View

Sies H, Jones D . Reactive oxygen species (ROS) as pleiotropic physiological signalling agents. Nat Rev Mol Cell Biol. 2020; 21(7):363-383. DOI: 10.1038/s41580-020-0230-3. View

10.

Aboussouan L, Golish J, Wood B, Mehta A, Wood D, Dinner D . Dynamic pharyngoscopy in predicting outcome of uvulopalatopharyngoplasty for moderate and severe obstructive sleep apnea. Chest. 1995; 107(4):946-51. DOI: 10.1378/chest.107.4.946. View

11.

Lee W, Wu C, Lin H, Lee I, Wu C, Tseng J . Visfatin-induced expression of inflammatory mediators in human endothelial cells through the NF-kappaB pathway. Int J Obes (Lond). 2009; 33(4):465-72. DOI: 10.1038/ijo.2009.24. View

12.

Joshi R, Adhikari S, Patro B, Chattopadhyay S, Mukherjee T . Free radical scavenging behavior of folic acid: evidence for possible antioxidant activity. Free Radic Biol Med. 2001; 30(12):1390-9. DOI: 10.1016/s0891-5849(01)00543-3. View

13.

Sha S, Taylor R, Forge A, Schacht J . Differential vulnerability of basal and apical hair cells is based on intrinsic susceptibility to free radicals. Hear Res. 2001; 155(1-2):1-8. DOI: 10.1016/s0378-5955(01)00224-6. View

14.

Wu X, Chang S, Jin J, Gu W, Li S . NLRP3 inﬂammasome mediates chronic intermittent hypoxia-induced renal injury implication of the microRNA-155/FOXO3a signaling pathway. J Cell Physiol. 2018; 233(12):9404-9415. DOI: 10.1002/jcp.26784. View

15.

Elias T, da Costa Monsanto R, do Amaral J, Oyama L, Maza P, Penido N . Evaluation of Oxidative-Stress Pathway and Recovery of Sudden Sensorineural Hearing Loss. Int Arch Otorhinolaryngol. 2021; 25(3):e428-e432. PMC: 8321640. DOI: 10.1055/s-0040-1714130. View

16.

Randerath W, Verbraecken J, Andreas S, Bettega G, Boudewyns A, Hamans E . Non-CPAP therapies in obstructive sleep apnoea. Eur Respir J. 2011; 37(5):1000-28. DOI: 10.1183/09031936.00099710. View

17.

Shi X . Physiopathology of the cochlear microcirculation. Hear Res. 2011; 282(1-2):10-24. PMC: 3608480. DOI: 10.1016/j.heares.2011.08.006. View

18.

Lavie L . Obstructive sleep apnoea syndrome--an oxidative stress disorder. Sleep Med Rev. 2003; 7(1):35-51. DOI: 10.1053/smrv.2002.0261. View

19.

Niki E . Lipid peroxidation: physiological levels and dual biological effects. Free Radic Biol Med. 2009; 47(5):469-84. DOI: 10.1016/j.freeradbiomed.2009.05.032. View

20.

Wang F, Liu Y, Xu H, Qian Y, Zou J, Yi H . Association between Upper-airway Surgery and Ameliorative Risk Markers of Endothelial Function in Obstructive Sleep Apnea. Sci Rep. 2019; 9(1):20157. PMC: 6934655. DOI: 10.1038/s41598-019-56601-w. View