From the Guidelines
Elevated ferritin levels in patients with obstructive sleep apnea (OSA) should be managed by treating the underlying OSA with continuous positive airway pressure (CPAP) therapy, as it is the most effective way to reduce inflammation and potentially normalize ferritin levels. The relationship between ferritin elevation and OSA is complex, and it is essential to determine whether the elevated ferritin is secondary to OSA-related inflammation or due to other causes like hemochromatosis or liver disease 1. OSA causes intermittent hypoxia and sleep fragmentation, which can trigger systemic inflammation and oxidative stress, potentially leading to increased ferritin levels as part of an acute phase response.
Some key points to consider in managing OSA and elevated ferritin levels include:
- CPAP therapy typically involves wearing a mask during sleep that delivers pressurized air to keep the airway open, and it should be used whenever sleeping, including naps.
- Lifestyle modifications such as weight loss (if overweight), avoiding alcohol and sedatives before bedtime, and sleeping on your side can help manage OSA symptoms.
- Regular monitoring of ferritin levels is recommended while treating the OSA to track improvement.
- The diagnosis of OSA involves measuring breathing during sleep, and the third edition of the International Classification of Sleep Disorders (ICSD-3) defines OSA as a PSG-determined obstructive respiratory disturbance index (RDI) ≥ 5 events/h associated with the typical symptoms of OSA 1.
- Treatment of OSA has been shown to improve quality of life, lower the rates of motor vehicle accidents, and reduce the risk of chronic health consequences of untreated OSA, including cardiovascular disease and metabolic dysregulation 1.
From the Research
Ferritin Elevation and OSA
- Ferritin is an intracellular iron storage protein and a marker of inflammation, and its levels have been studied in relation to obstructive sleep apnea (OSA) 2, 3.
- A study found that serum ferritin levels were significantly higher in OSA males than controls, but after adjusting for confounders, no significant difference was found 2.
- However, another study found that serum ferritin levels were significantly positively correlated with the apnea-hypopnea index (AHI), and a clear trend of higher serum ferritin levels was found in patients with severe OSA compared to those without or with mild OSA 3.
- The relationship between ferritin levels and OSA severity is not fully understood, but serum ferritin levels may provide a biochemical surrogate marker for OSA severity 3.
- OSA is a common problem, with a high prevalence in the general population, and is associated with various acute and chronic inflammatory diseases 4, 5.
- Treatment of OSA with continuous positive airway pressure (CPAP) has been shown to be effective in reducing symptoms and improving quality of life, but the relationship between CPAP treatment and ferritin levels is not well studied 2, 6.