Summary: Continuous positive airway pressure (CPAP) treatment for obstructive sleep apnea (OSA) can reduce the accelerated telomere shortening caused by the condition.
Telomeres, the protective ends of chromosomes, play a role in aging and tend to shorten more quickly in OSA. This study shows that CPAP not only fights OSA symptoms, but also reduces the effects of rapid aging. The results illustrate the crucial connection between sleep quality and aging.
Important facts:
Continuous positive airway pressure (CPAP) may moderate the accelerated telomere shortening seen in patients with obstructive sleep apnea (OSA).
The study at UNIFESP enrolled 46 male patients aged 50 to 60 who were diagnosed with moderate to severe OSA. It was found that CPAP also reduces inflammation.
The effects of OSA are so profound that severe OSA is equivalent to aging another ten years.
Source: FAPESP
Obstructive sleep apnea (OSA) consists of multiple episodes of partial or complete obstruction of the upper airway that occur during sleep, resulting in pauses in breathing lasting more than ten seconds and sometimes even several minutes, followed by states of agitation and deep breathing.
Symptoms include poor concentration, fatigue, and excessive daytime sleepiness, all of which can affect quality of life and lead to disability. Untreated patients are at risk of high blood pressure, cardiovascular disease, heart failure and diabetes, as well as memory and concentration disorders.
They also analyzed inflammatory and oxidative stress markers. Photo credit: Neuroscience News
A study conducted at the Federal University of São Paulo (UNIFESP) in Brazil shows that telomere shortening, which occurs naturally with age and is accelerated by OSA, can be alleviated with the use of continuous positive airway pressure (CPAP), a method of respiratory therapy During spontaneous breathing, air is pumped through the nose and mouth into the lungs.
Telomeres are structures made up of DNA sequences and proteins found at the ends of chromosomes. They play a central role in maintaining the integrity of the genetic material in cell nuclei. They naturally shorten as cells divide to regenerate tissues and organs, and aging cells stop dividing when telomeres become too short. Accelerated shortening of the telomeres by OSA can therefore lead to premature cell aging.
The study was supported by FAPESP and described in an article published in the journal Sleep.
Researchers studied 46 male patients aged 50 to 60 diagnosed with moderate or severe OSA for six months. They divided these volunteers into two groups and treated one with CPAP and the other with placebo (a CPAP machine with a hidden leak in the mask’s vent to distribute therapeutic pressure).
At monthly visits, they checked compliance with CPAP, which was considered complex and took some getting used to. At the beginning of the trial, three months later and at the end of the procedure, they took blood samples to measure telomere length. They also analyzed inflammatory and oxidative stress markers.
“Telomere shortening is inevitable as it is associated with aging, inflammation and oxidative stress, but OSA accelerates it and we found that CPAP moderated this acceleration at three and six months,” said Priscila Farias Tempaku, first author of the article and Sleep Biology Researcher at UNIFESP’s Department of Psychobiology.
In examining the molecular mechanisms involved in OSA and telomere shortening, the researchers found that inflammation is likely the main pathway via tumor necrosis factor alpha (TNF-α), a cytokine known to be involved in the pathogenesis of some inflammatory and autoimmune diseases .
“In the placebo group, TNF-α affected telomere length, while this association was not observed in the CPAP group. This demonstrates that in addition to its already recognized importance in reducing cardiovascular and metabolic risk, CPAP also reduces inflammation and thus mitigates telomere shortening,” Tempaku explained.
“The results underscore the importance of sleep as a protective factor in aging and as a risk factor in patients with changes.” This is an excellent incentive since most people are reluctant to use CPAP,” said Sergio Tufik, the last author of the article and head of the Sleep Institute UNIFESP.
sleep epidemiology
As a pioneer of sleep research in Brazil and worldwide, Professor Tufik founded the Episono (“Episleep”) project to study sleep epidemiology. He and his team have been conducting surveys of the population of the city of São Paulo every decade since 1986 to find out what sleep-related health problems they have, including insomnia, snoring and sleepwalking, and have published more than 70 articles on the subject in scientific journals.
The 2015 round of surveys focused on the impact of telomere shortening over a 10-year period, showing that severe OSA was equivalent to aging by 10 years. These findings, along with the results of the latest study, led the researchers to conclude that they should look more deeply into the links between sleep and aging.
“People age faster when they sleep poorly. Poor sleep quality is associated with mortality, as are other diseases. About 30% of the population suffers from OSA, but the condition is not treated. CPAP is not provided by public or private health services and that needs to change,” Tufik said.
The prevalence of OSA increases with the progression of obesity because the two diseases are often associated. According to the Brazilian Society of Bariatric and Metabolic Surgery (SBCBM), 70% of overweight people suffer from sleep disorders. In the case of morbid obesity, the proportion is 80%.
Diagnosing OSA requires a polysomnography test, also called a sleep study. Treatment includes CPAP and lifestyle changes such as weight loss and avoiding sleeping pills and alcoholic beverages at night.
Abstract
Influence of obstructive sleep apnea and CPAP on telomere length and associated mechanisms
introduction
There is increasing evidence that obstructive sleep apnea (OSA) contributes to the molecular signaling pathways of aging that are related to the maintenance of telomere length. The aim of the present study was to investigate the effect of OSA and its treatment with continuous positive airway pressure (CPAP) on telomere length variation and the associated mechanisms.
methods
For this purpose, a 6-month randomized, double-blind and sham-controlled clinical study was carried out. Participants were randomized to receive CPAP or sham CPAP treatment and participated in seven visits during which they underwent clinical examination and blood sampling to measure mean leukocyte telomere length (LTL) and dosing of metabolic and determine inflammatory markers.
Results
Of the 127 people we contacted, 46 met the inclusion criteria. At baseline, subjects in both groups were homogeneous, including LTL (p=0.106). Adherence during the intervention was 5.29 ± 1.09 in the sham CPAP group and 5.71 ± 0.19 in the CPAP group. After 6 months of intervention, we observed a statistically significant treatment effect (p=0.001) on LTL, with the sham CPAP group (1.0117 ± 0.1552, 0.9457 ± 0.0747, 0.8482 ± 0 .2163) showed a more significant reduction than the CPAP group (1.0960 ± 0.1122, 1.0521 ± 0.1094, 1.0675 ± 0.1225). In addition, we found a negative correlation between Delta-LTL and Dela-TNF-α at Visit 7 and Visit 1 (rho=-0.216, p=0.003) due to the sham CPAP intervention (rho=-0.383, p=0.009) . for use of CPAP (rho=0.021, p=0.800).
Diploma
We can conclude that CPAP had an effect on LTL stability compared to sham CPAP-placebo, possibly through modulation of TNF-α.
support (if any)
Our studies are supported by the Associação Fundo de Incentivo à Pesquisa (AFIP), the Fundação de Amparo à Pesquisa de São Paulo (FAPESP), the Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES) and the Conselho Nacional de Desenvolvimento Científico Tecnológico (VA and ST) supports CNPq grants).