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July 2, 2026Sleep Medicine ResearchOpen Access

Association Between Intermittent Hypoxia and Systemic Inflammation in Obese Patients With Obstructive Sleep Apnea: Mediating Role of HIF-1α and Metabolic Predictors

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Why the study?

The contribution of intermittent hypoxia and HIF-1alpha to systemic inflammation in obese patients with OSA remained unclear in Indian populations.

Is obstructive sleep apnea associated with increased systemic inflammation via HIF-1α in obese adults?

Population

90 obese adults

Comparison

45 patients with OSA vs 45 BMI- and age-matched controls

Design

Hospital-based case-control study

Key result

Obstructive sleep apnea in obese adults was associated with significantly higher median serum IL-6 (5.6 vs 2.3 pg/mL, p<0.001) and other inflammatory markers compared to matched controls.

Authors

SSSohini SahaInstitute of Medical Sciences and Sum HospitalMMMeghanad MeherInstitute of Medical Sciences and Sum Hospital

Discussion

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Overview

Hypothesis-generating for HIF-1α inflammation pathways in obese OSA; should not yet change clinical practice.

Key Points

  • This study aims to understand the relationship between intermittent hypoxia and systemic inflammation in obese patients with obstructive sleep apnea, focusing on HIF-1α as a mediator.
  • Included 90 obese adults (BMI ≥30 kg/m²), 45 with OSA and 45 matched controls.
  • Measured AHI, ODI, SpO₂ via polysomnography and inflammatory markers (IL-6, TNF-α, CRP, HIF-1α) using ELISA.
  • Used multiple regression and bootstrapped mediation analysis to identify predictors and mediation effects.
  • OSA group showed higher ODI, lower SpO₂, and elevated levels of inflammatory markers (IL-6, CRP, TNF-α, HIF-1α; all p<0.001).
  • ODI was the strongest predictor for IL-6 (β=0.55), CRP (β=0.40), TNF-α (β=0.67), and HIF-1α (β=0.62; all p≤0.001).
  • HIF-1α partially mediated the relationship between ODI and inflammation.

Study Design

Type

Case-Control (n=90)

Multicenter

No

Structured PICO

Is obstructive sleep apnea associated with increased systemic inflammation via HIF-1α in obese adults?

P
Population
90 obese adults aged 18-65 years, including 45 with newly diagnosed obstructive sleep apnea and 45 age- and BMI-matched controls, evaluated in a cross-sectional setting.
E
Exposure
Obstructive sleep apnea (intermittent hypoxia measured by ODI)
C
Comparator
BMI- and age-matched controls without OSA (AHI <5 events/h)
O
Outcome
Systemic inflammation (IL-6, TNF-α, CRP) and HIF-1α levelssurrogate

Main Result

Effect estimate: Effect size r=0.86

Absolute Event Rate: 5.6% vs 2.3%

p-value: p=<0.001

Limitations

  • Cross-sectional design precludes establishing causality
  • Sample size may have limited detection of subtle interactions
  • Residual confounding from smoking, alcohol, medications, and comorbidities cannot be entirely ruled out
  • Recruitment from a single tertiary center introduces potential selection bias
  • Control participants had non-OSA sleep complaints such as insomnia
  • ODI does not capture the duration of hypoxemia, which may be better reflected by indices such as T90

Cite This Study

Saha et al. (2026) conducted a case-control in Obstructive sleep apnea in obesity (n=90). Obstructive sleep apnea vs. Obese adults without obstructive sleep apnea was evaluated on Serum interleukin-6 (IL-6) concentration (pg/mL) (Effect size r=0.86, p=<0.001). Obstructive sleep apnea in obese adults was associated with significantly higher median serum IL-6 (5.6 vs 2.3 pg/mL, p<0.001) and other inflammatory markers compared to matched controls.

synapsesocial.com/papers/6a45fffc9ed134303131041bhttps://doi.org/10.17241/smr.2026.03538
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Also Consider

Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context:

  1. 1Increased Inflammatory Activity in Nonobese Patients with Coronary Artery Disease and Obstructive Sleep Apnea2015 · 42 citations
  2. 2Role of Hypoxia-Inducible Factor-1α in the Pathophysiology of Non-Alcoholic Fatty Liver Disease Among Obstructive Sleep Apnea Patients: A Case-Control Study2026
  3. 3Evaluation the Possible Role of Interleukin-6 and Tumor Necrosis Factor- Alpha in Pathogenesis of Obstructive Sleep Apnea in Obese Patients: A Case-Control Study2022 · 5 citations
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