The telomere shortening that naturally occurs with aging and is accelerated by obstructive sleep apnea (OSA) can be mitigated by the use of continuous positive airway pressure (CPAP), according to a study conducted at the Federal University of São Paulo (UNIFESP) in Brazil.

Telomeres are structures made from 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 tissue and organs, and aging cells stop dividing when telomeres become too short. Accelerated telomere shortening due to OSA can therefore lead to premature cell aging. 

The study was supported by FAPESP and published in Sleep.

The researchers assessed 46 male patients aged 50-60 and diagnosed with moderate or severe OSA for six months. They divided these volunteers into two groups, treating one with CPAP and the other with placebo (a CPAP machine with a hidden leak in the exhaust port of the mask to disperse the therapeutic pressure).

In monthly visits, they checked adherence to CPAP and took blood samples to measure telomere length at the start of the trial, three months later, and at the end of the intervention. They also analyzed inflammatory and oxidative stress markers.

“Telomere shortening is inevitable because it’s associated with aging, inflammation, and oxidative stress, but OSA accelerates it. And we found that CPAP attenuated this acceleration after three and six months,” says Priscila Farias Tempaku, first author of the article and a researcher in sleep biology at UNIFESP’s Department of Psychobiology, in a release.

In their investigation of the molecular mechanisms associated with OSA and telomere shortening, the researchers observed that inflammation is probably 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 influenced telomere length, whereas the association wasn’t observed in the CPAP group. This shows that in addition to its already recognized importance in mitigating cardiovascular and metabolic risk, CPAP also reduces inflammation and therefore attenuates telomere shortening,” Tempaku says in teh release.

“The results underscore the criticality of sleep as a protective factor in aging and a risk factor in patients with alterations. This is an excellent incentive since most people are reluctant to use CPAP,” says Sergio Tufik, PhD, last author of the article and head of UNIFESP’s Sleep Institute, in a release.  

Sleep Epidemiology

A pioneer of sleep research in Brazil and worldwide, Professor Tufik created the Episono (“Episleep”) project to investigate sleep epidemiology. He and his team have conducted surveys of the population of São Paulo city every decade since 1986 to find out about their sleep-related health problems, including insomnia, snoring, and sleepwalking, and have published more than 70 articles on the subject in scientific journals. 

The 2015 round of the survey focused on the effects of telomere shortening over a period of 10 years, showing that having severe OSA was equivalent to aging 10 years. This finding, alongside those of the latest study, led the researchers to conclude that they should investigate the links between sleep and aging in more depth.

“People age faster when they sleep badly. Poor quality sleep is associated with mortality as much as other diseases. Around 30% of the population have OSA, but there’s no care for the disorder. CPAP isn’t provided by public or private health services, and this has to change,” Tufik says in a release.

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