Circulating markers of biological aging associated with obstructive sleep apnea or insomnia in adults: A systematic review and meta-analysis.

Obstructive sleep apnea (OSA) and insomnia could accelerate biological aging through pathways including oxidative stress and systemic inflammation. This systematic review aimed to determine the association of sleep disorders with circulating markers of biological aging. We searched MEDLINE, Embase, CINAHL, Cochrane, PsycINFO from inception to October 2024. Eligibility criteria included full manuscript English studies on adult humans examining OSA or insomnia and circulating markers of aging. Of the 1839 deduplicated records screened, 49 full-text studies were eligible for inclusion. Included studies ranged from poor to good quality and assessed telomere length (TL), DNA methylation clocks (epigenetics), mitochondrial alterations, sirtuin levels and activity, autophagy protein levels, and klotho gene expression. Telomeres were the most extensively studied marker, with our findings showing a significant association between TL and OSA, based on both unadjusted and adjusted values (SMD = -0.451, 95% CI: 0.688 to -0.215, p = 0.0026 and SMD = -3.01, 95% CI: 4.98 to -1.04, p = 0.033, respectively). Most studies linked insomnia and poor sleep quality to shorter TL. Although evidence for other aging biomarkers was more limited, the published literature supports the role of OSA and insomnia in accelerating biological aging, especially for telomere length.