Abstract
Obstructive sleep apnoea (OSA) is a major public health concern, strongly linked to cardiovascular disease and cancer. Extracellular vesicles (EVs) have emerged as key mediators in intercellular communication, oxidative stress and inflammation, carrying molecules that can influence OSA pathophysiology. However, their role in OSA pathophysiology remains underexplored. This systematic review consolidates current research on EVs in OSA, focusing on their cargo, surface proteins and impact on oxidative stress, inflammation, cancer progression and cardiovascular dysfunction. Registered in the International Prospective Register of Systematic Reviews (ID CRD 42024537136), it explores the intricate links between OSA and EVs to uncover disease mechanisms and identify potential biomarkers. The search was conducted in PubMed/Medline and Web of Science databases to identify studies exploring OSA and EVs in clinical studies, animal studies and in vitro studies. Among the 600 unique studies screened, 27 met the inclusion criteria. These studies demonstrated that OSA-derived EVs influence key biological processes, such as endothelial dysfunction, inflammation and tumour cell proliferation. Transcriptomic and proteomic analyses revealed dysregulation of specific microRNAs and proteins in EVs from OSA patients in comparison with controls. Notably, EVs studies in clinical, animal and in vitro settings were shown to enhance cancer cell migration and endothelial dysfunction, underscoring their potential as biomarkers for OSA-related comorbidities. EVs hold great promise as minimally invasive, cost-effective biomarkers for understanding OSA mechanisms, diagnosis and prognosis. However, stricter characterisation and comprehensive profiling of their dynamics and cargo are essential to standardise methodologies and clarify their role in the disease.