image: Obstructive Sleep Apnea (OSA) or Intermittent Hypoxia (IH) stimulates diverse donor cells (like macrophages and tumor cells) to release exosomes loaded with various signaling molecules (miRNAs, proteins, etc.). These exosomes act as messengers, transferring their cargo to a wide array of recipient cells (including endothelial cells, neurons, and adipocytes) to trigger pathological responses such as inflammation, cell activation, and proliferation.
Credit: Ruoyun Ouyang from Central South University
Obstructive sleep apnea (OSA), a global public health issue marked by repeated upper airway collapse during sleep, is tied to diverse diseases—from cardiovascular conditions to cancer. Now, a comprehensive review published in Chinese Medical Journal identifies exosomes as critical mediators in this process.
Exosomes, 30-150 nm extracellular vesicles, shuttle cargo like microRNAs (miRNAs), proteins, and lipids between cells. The review, led by researchers from Central South University’s Second Xiangya Hospital, notes OSA-induced intermittent hypoxia (IH) and sleep fragmentation (SF) alter exosome secretion and content. These modified exosomes then disrupt cell function: for example, OSA patients’ plasma exosomes trigger endothelial cell aging and dysfunction, accelerating atherosclerosis, while exosomal miR-20a-5p damages hippocampal neurons, worsening cognitive impairment.
In metabolic diseases, adipose tissue-derived exosomes with miR-155 induce insulin resistance in OSA, and exosomal miR-421 promotes non-alcoholic fatty liver disease (NAFLD) by inhibiting liver cell pathways. For cancer, IH-altered exosomes boost lung cancer and melanoma cell proliferation; notably, continuous positive airway pressure (CPAP)—OSA's gold-standard treatment—partially reverses these exosome-driven effects.
Yet exosomes are not just pathogenic. The review spotlights their therapeutic potential: mesenchymal stem cell (MSC)-derived exosomes with miR-122 enhance chemotherapy sensitivity in liver cancer, while microglial exosomal miR-146a-5p reduces OSA-related neuroinflammation.
"Exosomes bridge OSA and its comorbidities," said Ruoyun Ouyang, corresponding author. "Further research could unlock exosome-based biomarkers and therapies to improve OSA patients' outcomes."
***
Reference
DOI: https://doi.org/10.1097/CM9.0000000000003784
Journal
Chinese Medical Journal
Method of Research
Literature review
Subject of Research
Cells
Article Title
Exosomes in obstructive sleep apnea-related diseases
Article Publication Date
4-Sep-2025