From the Research
No, obstructive sleep apnea (OSA) does not typically cause erythrocytosis, as the increase in erythropoietin due to intermittent hypoxia is offset by neocytolysis and inflammation-mediated suppression of erythropoiesis. This conclusion is based on the most recent and highest quality study available, which found that despite the expected increase in erythropboietin, patients with OSA did not develop significant erythrocytosis due to the counterbalance of these opposing mechanisms 1. The study analyzed 527 patients with OSA and found that over 98% did not have an elevated hemoglobin level, and further investigation revealed that the red cell mass was normal, and that neocytolysis and inflammation-induced hepcidin limited iron availability for erythropoiesis.
Key points to consider:
- The increase in erythropoietin due to intermittent hypoxia in OSA is not sufficient to cause significant erythrocytosis
- Neocytolysis, or the lysis of newly generated red blood cells, offsets the increase in erythropboietin
- Inflammation-mediated suppression of erythropoiesis also contributes to the lack of erythrocytosis in OSA
- Treatment with continuous positive airway pressure (CPAP) may reduce some of the intermediaries involved in neocytolysis and inflammation, but does not typically result in significant changes in hemoglobin levels 1.
Other studies have reported varying results, but the most recent and highest quality study suggests that OSA does not typically cause erythrocytosis 2, 3, 4, 5. Therefore, the most accurate answer is that OSA does not typically cause erythrocytosis, and treatment should focus on addressing the underlying sleep apnea rather than managing erythrocytosis.