Sleep apnea: device softens aging – 07/17/2023 – Health

People with obstructive sleep apnea experience repeated pauses in breathing throughout the night, which can last for a few seconds or even minutes and are followed by awakenings that impair the quality of sleep. If left untreated, the disorder can, over the years, cause health problems such as increased cardiovascular risk, hypertension, heart failure, diabetes, and impaired memory and concentration.

Research carried out at the Federal University of São Paulo (Unifesp) revealed that apnea also promotes the reduction of telomeres —structures present at the ends of chromosomes and which have the role of maintaining the integrity of the genetic material existing in the cell nucleus.

Telomeres naturally shorten as cells divide to regenerate the body’s tissues and organs. And when they get too small, the aging cell stops multiplying. As it accelerates this telomere shortening process, therefore, apnea promotes premature aging of cells.

The good news from the studies conducted at Unifesp is that the problem can be alleviated with the use of CPAP (continuous positive airway pressure) – a device attached to a mask that blows air into the nose during sleep and regularizes breathing. The most recent results were published in the journal Sleep.

With support from FAPESP, the researchers followed 46 male patients, aged between 50 and 60 years, with moderate or severe sleep apnea for six months. The volunteers were divided into two groups and treated with CPAP or a similar device, however, with air leaks that do not allow the therapeutic effect and work as a placebo.

During monthly visits, the scientists checked the patients’ adherence to the device, a therapy considered complex and uncomfortable, and collected blood to measure telomere length –an analysis carried out on three occasions– at the beginning of the experiment, after a period of three months and at the end of the intervention. In addition, blood markers of inflammation and oxidative stress were analyzed.

“The shortening of telomeres is inevitable because it is related to inflammation and the oxidative stress of aging, but we found that people with apnea present an acceleration of this process”, explains Priscila Farias Tempaku, researcher in the area of ​​medicine and sleep biology at the Department of Psychobiology from Unifesp and author of the study. “We also observed that, both at three and six months, the use of CPAP attenuated this acceleration.”

The researchers also investigated the molecular mechanisms that involve the association between apnea and telomeres. One of these mediators, the inflammatory marker TNF-α, shows that inflammation is probably the molecular pathway involved.

“In the patients who used the placebo, the molecule proved to be an influential factor in telomere length; in those who used CPAP, however, there was no such association, showing that, in addition to its already known importance in reducing cardiovascular and metabolic risk, the device it also decreases inflammation and, consequently, attenuates telomere shortening”, explains Tempaku.

“The results make clear the role of sleep as a protective factor for aging or as a risk factor for those with any alteration”, evaluates Sergio Tufik, director of the Unifesp Institute of Sleep and coordinator of the study. “This is a great incentive, as most people are resistant to using CPAP.”

episode

A pioneer in studies on sleep in Brazil and around the world, Tufik is the creator of the Epidemiological Study of Sleep (Episono) project, carried out every decade since 1986 to draw a complete picture of the sleep of São Paulo residents from the perspective of public health. In addition to establishing the prevalence of problems such as snoring, sleepwalking and insomnia, the work has already resulted in the publication of more than 70 articles in scientific journals.

The 2015 edition of Episono, which evaluated the size of the effect of telomere shortening over a ten-year period, showed that having severe apnea is equivalent to aging ten years. This information, added to the findings of the current work, indicate the researchers’ next path: to bring even more attention to the relationship between sleep and aging.

“Sleeping poorly ages, is associated with mortality as much as other diseases and sleep apnea occurs in 30% of people,” says Tufik. “But the population is unassisted, since neither the public system nor the agreements offer CPAP – this needs to change”, warns the researcher.

The prevalence of apnea has been increasing in parallel with the advance of obesity, since the diseases are often associated. Data from the Brazilian Society of Bariatric and Metabolic Surgery indicate that 70% of obese suffer from sleep disturbance, and the rate reaches 80% in the case of morbid obesity.

The main symptoms of obstructive sleep apnea are snoring, daytime fatigue and reduced ability to concentrate – factors that compromise quality of life and can be disabling. Diagnosis requires an examination known as polysomnography and treatment, in addition to the use of CPAP, usually involves lifestyle changes, including weight loss, reducing alcohol consumption at night and sleeping pills.

The article Effect of Obstructive Sleep Apnea and CPAP on Telomere Length and its Associated Mechanisms can be read here.