---
title: "Obstructive Sleep Apnea and Skin Wound Healing: Intermittent Hypoxia Effects and Clinical Evidence"
id: "pubmed-42773334"
canonical_url: "https://medichelpline.com/clinical-feed/pubmed-42773334"
content_type: "clinical_feed_article"
specialty: "Critical Care"
source_name: "PubMed / NCBI"
source_url: "https://pubmed.ncbi.nlm.nih.gov/42773334/"
doi: "10.1007/s11325-026-03804-x"
published_at: "2026-09-23T00:00:00.000Z"
evidence_level: "Journal Article"
license: "CC-BY-NC-4.0 / Informational Use"
---
# Obstructive Sleep Apnea and Skin Wound Healing: Intermittent Hypoxia Effects and Clinical Evidence
## Provenance & Clinical Metadata
- **Canonical URL:** https://medichelpline.com/clinical-feed/pubmed-42773334
- **Specialty:** [Critical Care](https://medichelpline.com/clinical-feed/critical-care.md)
- **Primary Source:** PubMed / NCBI
- **Source URL:** [Original Journal Publication](https://pubmed.ncbi.nlm.nih.gov/42773334/)
- **DOI:** [10.1007/s11325-026-03804-x](https://doi.org/10.1007%2Fs11325-026-03804-x)
- **Published At:** 2026-09-23T00:00:00.000Z
- **Evidence Rating:** Journal Article
## Executive GIST (TL;DR)
- Adequate tissue oxygenation is essential for effective **wound healing**; hypoxia contributes to impaired healing and chronic wound formation. - **Obstructive sleep apnea (OSA)** produces repetitive cycles of oxygen desaturation and reoxygenation during sleep, termed **intermittent hypoxia (IH)**, which activates molecular pathways distinct from acute or chronic hypoxia. - OSA is highly prevalent worldwide (nearly one billion adults) and substantially underdiagnosed (up to 80% of cases), suggesting it may be an overlooked contributor to impaired wound healing. - OSA may impair healing indirectly by promoting comorbidities (diabetes, hypertension, obesity) and directly via IH-driven effects at cellular and tissue levels. - A literature search (PubMed/MEDLINE, Scopus, Web of Science) was performed through August 2026 to identify preclinical and clinical studies linking OSA, IH, and wound healing. - Proposed IH-driven mechanisms include reduced antioxidant capacity, sustained inflammation, sympathetic activation, and endothelial dysfunction that may hinder repair processes. - Preclinical evidence is limited and mainly from in vitro scratch assays; findings indicate IH delays wound closure, downregulates **HIF-2α** and **VEGF**, and skews macrophages toward a pro-inflammatory phenotype. - Clinical data are sparse and heterogeneous: in diabetic foot ulcers, high OSA risk was associated with a doubled risk of poor healing; improved ulcer healing after **CPAP** has been reported only in a small case series. - The review is the first to integrate cellular mechanisms, preclinical findings, and clinical data on OSA and skin wound healing, emphasizing limited and preliminary evidence and identifying OSA as a potentially modifiable factor. - Overall, current data support biological plausibility but underscore the need for more robust preclinical models and controlled clinical studies to clarify causality and the therapeutic impact of OSA treatment on wound outcomes.
## Clinical Analysis & Structured Key Points
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Affiliations Expand ### Affiliations * 1 Department of Otorhinolaryngology, Faculty of Medicine and Dentistry, Medical University of Warsaw, Warsaw, 02-091, Poland. * 2 Department of Experimental Physiology and Pathophysiology, Laboratory of Centre for Preclinical Research, Medical University of Warsaw, Warsaw, 02-091, Poland. * 3 Department of Otorhinolaryngology, Faculty of Medicine and Dentistry, Medical University of Warsaw, Warsaw, 02-091, Poland. wojciech.kukwa@wum.edu.pl. * PMID: **42773334** * DOI: [ 10.1007/s11325-026-03804-x ](https://doi.org/10.1007/s11325-026-03804-x) Item in Clipboard Review # The impact of obstructive sleep apnea on skin wound healing - from preclinical perspective to clinical evidence: A narrative review Łukasz Mazurek et al. Sleep Breath. 2026. Show details Display options Display options Format Abstract PubMed PMID Sleep Breath Actions * [ Search in PubMed ](https://pubmed.ncbi.nlm.nih.gov/?term=%22Sleep+Breath%22%5Bjour%5D&sort=date&sort_order=desc) * [ Search in NLM Catalog ](https://www.ncbi.nlm.nih.gov/nlmcatalog?term=%22Sleep+Breath%22%5BTitle+Abbreviation%5D) * [ Add to Search ](https://pubmed.ncbi.nlm.nih.gov/42773334/) . 2026 Sep 23;30(5):268. doi: 10.1007/s11325-026-03804-x. ### Authors [Łukasz Mazurek](https://pubmed.ncbi.nlm.nih.gov/?term=Mazurek+%C5%81&cauthor_id=42773334)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42773334/#short-view-affiliation-1 "Department of Otorhinolaryngology, Faculty of Medicine and Dentistry, Medical University of Warsaw, Warsaw, 02-091, Poland.")[ 2 ](https://pubmed.ncbi.nlm.nih.gov/42773334/#short-view-affiliation-2 "Department of Experimental Physiology and Pathophysiology, Laboratory of Centre for Preclinical Research, Medical University of Warsaw, Warsaw, 02-091, Poland."), [Ewa Migacz](https://pubmed.ncbi.nlm.nih.gov/?term=Migacz+E&cauthor_id=42773334)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42773334/#short-view-affiliation-1 "Department of Otorhinolaryngology, Faculty of Medicine and Dentistry, Medical University of Warsaw, Warsaw, 02-091, Poland."), [Marek Konop](https://pubmed.ncbi.nlm.nih.gov/?term=Konop+M&cauthor_id=42773334)[ 2 ](https://pubmed.ncbi.nlm.nih.gov/42773334/#short-view-affiliation-2 "Department of Experimental Physiology and Pathophysiology, Laboratory of Centre for Preclinical Research, Medical University of Warsaw, Warsaw, 02-091, Poland."), [Wojciech Kukwa](https://pubmed.ncbi.nlm.nih.gov/?term=Kukwa+W&cauthor_id=42773334)[ 3 ](https://pubmed.ncbi.nlm.nih.gov/42773334/#short-view-affiliation-3 "Department of Otorhinolaryngology, Faculty of Medicine and Dentistry, Medical University of Warsaw, Warsaw, 02-091, Poland. wojciech.kukwa@wum.edu.pl.") ### Affiliations * 1 Department of Otorhinolaryngology, Faculty of Medicine and Dentistry, Medical University of Warsaw, Warsaw, 02-091, Poland. * 2 Department of Experimental Physiology and Pathophysiology, Laboratory of Centre for Preclinical Research, Medical University of Warsaw, Warsaw, 02-091, Poland. * 3 Department of Otorhinolaryngology, Faculty of Medicine and Dentistry, Medical University of Warsaw, Warsaw, 02-091, Poland. wojciech.kukwa@wum.edu.pl. * PMID: **42773334** * DOI: [ 10.1007/s11325-026-03804-x ](https://doi.org/10.1007/s11325-026-03804-x) Item in Clipboard Cite Display options Display options Format Abstract PubMed PMID ## Abstract **Purpose:** Adequate tissue oxygenation is essential for effective skin wound healing. Hypoxia contributes to impaired healing and chronic wound formation. Obstructive sleep apnea (OSA) affects nearly one billion adults worldwide, and up to 80% of cases remain undiagnosed. OSA causes intermittent hypoxia (IH), with repetitive cycles of oxygen desaturation and reoxygenation during sleep. The molecular pathways activated by IH differ from those induced by acute and chronic hypoxia. We propose that OSA may contribute to impaired wound healing in two ways. Indirectly, by promoting comorbidities such as diabetes, hypertension, and obesity. Directly, through IH and its effects at the cellular and tissue level. **Methods:** PubMed/MEDLINE, Scopus, and Web of Science were searched through August 2026 for preclinical and clinical studies on OSA, IH, and wound healing. **Results:** To our knowledge, this is the first review to integrate cellular mechanisms, preclinical evidence, and clinical data on this topic. We describe the IH-driven mechanisms that may contribute to impaired wound healing, including reduced antioxidant capacity, sustained inflammation, sympathetic activation, and endothelial dysfunction. Preclinical evidence is limited and mostly derives from in vitro scratch assays. It shows that IH delays wound closure, downregulates HIF-2α and VEGF, and shifts macrophages toward a pro-inflammatory phenotype. Clinical data are also limited and heterogeneous. In diabetic foot ulcers, high OSA risk doubled the risk of poor healing. Improved ulcer healing after CPAP has been described only in a small case series. **Conclusion:** Given its high prevalence and underdiagnosis, OSA may be an overlooked and potentially modifiable factor in impaired wound healing. **Keywords:** Chronic wounds; Intermittent hypoxia; Obstructive sleep apnea; Wound healing. © 2026. The Author(s). [PubMed Disclaimer](https://pubmed.ncbi.nlm.nih.gov/disclaimer/) ## Conflict of interest statement Declarations. Ethics approval: As this article was a review, no ethics approval was required. Conflict of interest: None of the authors have any conflicts of interest to declare. ## References 1. 1. Jin C, Jin Y, Ding Z, Nuch KS, Han M, Shim J et al (2025) Cellular and molecular mechanisms of wound repair: from biology to therapeutic innovation. Cells 14(23):1850. - [DOI](https://doi.org/10.3390/cells14231850) - [PubMed](https://pubmed.ncbi.nlm.nih.gov/41369338/) - [PMC](https://pmc.ncbi.nlm.nih.gov/articles/12691224/) 2. 1. Guo S, DiPietro LA (2010) Critical review in oral biology & medicine: Factors affecting wound healing. J Dent Res 89(3). 3. 1. Frykberg RG, Banks J (2015) Challenges in the Treatment of Chronic Wounds. Adv Wound Care (New Rochelle) 4(9):560–582. - [DOI](https://doi.org/10.1089/wound.2015.0635) - [PubMed](https://pubmed.ncbi.nlm.nih.gov/26339534/) - [PMC](https://pmc.ncbi.nlm.nih.gov/articles/4528992/) 4. 1. Armstrong DG, Boulton AJM, Bus SA (2017) Diabetic Foot Ulcers and Their Recurrence. N Engl J Med 376(24):2367–2375. - [DOI](https://doi.org/10.1056/nejmra1615439) - [PubMed](https://pubmed.ncbi.nlm.nih.gov/28614678/) 5. 1. Sharma S, Schaper N, Rayman G (2020) Microangiopathy: is it relevant to wound healing in diabetic foot disease? Diabetes Metab Res Rev 36(S1):e3244. - [DOI](https://doi.org/10.1002/dmrr.3244) - [PubMed](https://pubmed.ncbi.nlm.nih.gov/31845461/) Show all 59 references ## Publication types * Review Actions * [ Search in PubMed ](https://pubmed.ncbi.nlm.nih.gov/?term=%22Review%22%5Bpt%5D&sort=date&sort_order=desc) * [ Search in MeSH ](https://www.ncbi.nlm.nih.gov/mesh?term=Review) * [ Add to Search ](https://pubmed.ncbi.nlm.nih.gov/42773334/) ## MeSH terms * Animals Actions * [ Search in PubMed ](https://pubmed.ncbi.nlm.nih.gov/?term=%22Animals%22%5BMeSH%5D&sort=date&sort_order=desc) * [ Search in MeSH ](https://www.ncbi.nlm.nih.gov/mesh?term=Animals) * [ Add to Search ](https://pubmed.ncbi.nlm.nih.gov/42773334/) * Humans Actions * [ Search in PubMed ](https://pubmed.ncbi.nlm.nih.gov/?term=%22Humans%22%5BMeSH%5D&sort=date&sort_order=desc) * [ Search in MeSH ](https://www.ncbi.nlm.nih.gov/mesh?term=Humans) * [ Add to Search ](https://pubmed.ncbi.nlm.nih.gov/42773334/) * Hypoxia* / physiopathology Actions * [ Search in PubMed ](https://pubmed.ncbi.nlm.nih.gov/?term=%22Hypoxia%2Fphysiopathology%22%5BMAJR%5D&sort=date&sort_order=desc) * [ Search in MeSH ](https://www.ncbi.nlm.nih.gov/mesh?term=Hypoxia) * [ Add to Search ](https://pubmed.ncbi.nlm.nih.gov/42773334/) * Skin* / physiopathology Actions * [ Search in PubMed ](https://pubmed.ncbi.nlm.nih.gov/?term=%22Skin%2Fphysiopathology%22%5BMAJR%5D&sort=date&sort_order=desc) * [ Search in MeSH ](https://www.ncbi.nlm.nih.gov/mesh?term=Skin) * [ Add to Search ](https://pubmed.ncbi.nlm.nih.gov/42773334/) * Sleep Apnea, Obstructive* / complications Actions * [ Search in PubMed ](https://pubmed.ncbi.nlm.nih.gov/?term=%22Sleep+Apnea%2C+Obstructive%2Fcomplications%22%5BMAJR%5D&sort=date&sort_order=desc) * [ Search in MeSH ](https://www.ncbi.nlm.nih.gov/mesh?term=Sleep+Apnea%2C+Obstructive) * [ Add to Search ](https://pubmed.ncbi.nlm.nih.gov/42773334/) * Sleep Apnea, Obstructive* / physiopathology Actions * [ Search in PubMed ](https://pubmed.ncbi.nlm.nih.gov/?term=%22Sleep+Apnea%2C+Obstructive%2Fphysiopathology%22%5BMAJR%5D&sort=date&sort_order=desc) * [ Search in MeSH ](https://www.ncbi.nlm.nih.gov/mesh?term=Sleep+Apnea%2C+Obstructive) * [ Add to Search ](https://pubmed.ncbi.nlm.nih.gov/42773334/) * Wound Healing* / physiology Actions * [ Search in PubMed ](https://pubmed.ncbi.nlm.nih.gov/?term=%22Wound+Healing%2Fphysiology%22%5BMAJR%5D&sort=date&sort_order=desc) * [ Search in MeSH ](https://www.ncbi.nlm.nih.gov/mesh?term=Wound+Healing) * [ Add to Search ](https://pubmed.ncbi.nlm.nih.gov/42773334/) [x] Cite Copy Download .nbib .nbib Format: AMA APA MLA NLM **Send To** * [Clipboard](https://pubmed.ncbi.nlm.nih.gov/42773334/) * [Email](https://account.ncbi.nlm.nih.gov/?back_url=https%3A%2F%2Fpubmed.ncbi.nlm.nih.gov%2F42773334%2F%23open-email-panel) * [Save](https://pubmed.ncbi.nlm.nih.gov/42773334/) * [My Bibliography](https://account.ncbi.nlm.nih.gov/?back_url=https%3A%2F%2Fpubmed.ncbi.nlm.nih.gov%2F42773334%2F%23open-bibliography-panel) * [Collections](https://account.ncbi.nlm.nih.gov/?back_url=https%3A%2F%2Fpubmed.ncbi.nlm.nih.gov%2F42773334%2F%23open-collections-panel) * [Citation Manager](https://pubmed.ncbi.nlm.nih.gov/42773334/) [x] NCBI Literature Resources [MeSH](https://www.ncbi.nlm.nih.gov/mesh/) [PMC](https://www.ncbi.nlm.nih.gov/pmc/) [Bookshelf](https://www.ncbi.nlm.nih.gov/books) [Disclaimer](https://pubmed.ncbi.nlm.nih.gov/disclaimer/) The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). 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