Exosomes identified as key mediators in obstructive sleep apnea and its comorbidities

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. Further research could unlock exosome-based biomarkers and therapies to improve OSA patients' outcomes."

Ruoyun Ouyang, corresponding author