Research from the University of Missouri (MU) may help reduce the risk of cardiovascular disease in certain patients with obstructive sleep apnea (OSA). OSA affects an estimated 22 million Americans; in addition to sleep problems, the condition can cause other health issues, including chronic heart failure, high blood pressure, and stroke.

Some patients with OSA are at an even higher risk of cardiovascular problems because of a phenomenon called ‘reverse dipping,’ which causes blood pressure to rise rather than drop during sleep. Most people experience lower blood pressure at night. Now, MU researchers have found a potential cause for reverse dipping that may help patients with OSA get the help they need before cardiovascular disease develops.

David Gozal, MD, University of Missouri School of Medicine.

David Gozal, MD, University of Missouri School of Medicine.

“We can now identify those with OSA at the highest risk of cardiovascular problems in order to prevent them from developing additional complications,” says David Gozal, MD, chair of child health at the MU School of Medicine. “We can treat those patients more aggressively to ensure they adhere to therapy and use their continuous positive airway pressure [CPAP] device properly.”

Gozal and MU collaborator Abdelnaby Khalyfa, PhD, studied 46 patients, aged 18 to 70, diagnosed with OSA. They identified 15 participants as having a rise in blood pressure during sleep, while the remaining 31 participants had blood pressure readings that either remained the same or declined at night. The researchers collected blood from each participant to study the messages cells produce and send to each other through microscopic packages called exosomes.

Abdelnaby Khalyfa, PhD, University of Missouri School of Medicine.

Abdelnaby Khalyfa, PhD, University of Missouri School of Medicine.

“We found that the cell messages coming from participants with nighttime elevated blood pressure were different from those transmitted in subjects with normal blood pressure,” Gozal says. “The altered messages caused the cells that line the blood vessels to become dysfunctional. Those disturbed vessels allowed inflammatory cells to enter the vessels’ walls, causing hardening of those vessels and leading to cardiovascular disease.”

Gozal says the cell message discovery will help clinicians personalize treatment for each patient diagnosed with OSA. A simple blood test administered at the beginning of a sleep study could indicate each patient’s cardiovascular risk. He adds that additional research is needed to study the patients at highest risk of cardiovascular complications from OSA to see if CPAP compliance can actually reduce blood pressure or normalize the cell messages used to determine a patient’s risk.


  1. Khalyfa A, Gozal D, Chan WC, Andrade J, Prasad B. Circulating plasma exosomes in obstructive sleep apnoea and reverse dipping blood pressure. Eur Respir J. 2020;55(1):pii: 1901072; doi: 10.1183/13993003.01072-2019.

Featured image:

Man wearing continuous positive airway pressure therapy (CPAP) mask for obstructive sleep apnea. Photo © Lochpalm, courtesy Dreamstime (ID 94585428).