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158 to assess the value of the serum HIF ‐1α level as a predictor of OSA. Patients and methods The study group in‐ cluded 84 patients who were referred to Sleep and Respiratory Disorders Center in Łódź (Po‐ land) with a presumptive diagnosis of OSA. All patients underwent standard nocturnal polysom‐ nography examination (Jaeger, Viasys Healthcare, Höchberg, Germany), and the results were scored according to the American Academy of Sleep Med‐ icine guidelines.8 Patients with chronic respira‐ tory disorders (such as bronchial asthma, chron‐ ic obstructive pulmonary disease, or any chronic pulmonary disorder resulting in respiratory fail‐ ure) were excluded from the study, as individuals with these conditions have been shown to have increased serum HIF ‐1α protein levels.9 Other ex‐ clusion criteria were chronic inflammatory dis‐ eases (such as lupus or inflammatory bowel dis‐ ease), infection within 1 month of blood collec‐ tion, and diagnosis of cancer (active or in medical history). Peripheral blood samples were collect‐ ed in the evening before and in the morning af‐ ter polysomnography, and then centrifuged. Se‐ rum was collected and stored at a temperature of –80oC. The HIF ‐1α concentration was assessed us‐ ing an enzyme ‐linked immunosorbent assay kit (Invitrogen, Carlsbad, California, United States). The study was approved by the Ethics Com‐ mittee of the Medical University of Lodz (RNN/77/18/KE). All patients provided written informed consent to participate in the study. Statistical analysis was performed with Statis‐ tica 13.1 (StatSoft, Tulsa, Oklahoma, United States). The receiver operating curve was creat‐ ed to assess the value of serum HIF ‐1α concen‐ trations as a predictor of OSA. Introduction The prevalence of obstructive sleep apnea (OSA) syndrome has greatly increased in re‐ cent years. It is estimated that almost 50% of men and 24% of women are affected by at least mod‐ erate OSA (apnea–hypopnea index [AHI] ≥15/h).1 Multiple screening tools have been developed to assess the risk of OSA, including various ques‐ tionnaires2 and parameters (eg, body mass in‐ dex).3 Similarly, there is an ongoing search for biochemical markers that might serve as predic‐ tors of the disorder. However, currently, none of them has a high predictive value for the diagno‐ sis of OSA.4,5 One of the typical complications of OSA is in‐ termittent hypoxemia, which manifests as desatu‐ rations on polysomnography.6 Hypoxia ‐inducible factor 1 (HIF ‐1) is a key regulator of cellular ox‐ ygen metabolism. It consists of 2 subunits: α, which is oxygen sensitive, and β, which is pro‐ duced in a continuous manner and is not oxygen dependent. Since hypoxia is characteristic for rap‐ idly proliferating tissues, such as tumor tissue, a considerable number of studies investigating HIF ‐1α focused on its effect on the formation and growth of tumor tissue. An increased expression of HIF ‐1α was observed in multiple cancers and correlated with a worse prognosis.7 The protein is also thought to be responsible for activation of a vast number of genes. For example, it activates genes associated with angiogenesis (eg, vascular endothelial growth factor) or glucose uptake by cells (glucose transporters 1 and 3).7 This explains the mechanisms whereby HIF ‐1α is involved in tumor progression and suggests its possible role in the development of OSA comorbidities. Thus, HIF ‐1α protein is a potential candidate for a di‐ agnostic marker in OSA. In this study, we aimed RESEARCH LETTER

Serum Hypoxia-Inducible Factor-1α protein level as a diagnostic marker of obstructive sleep apnea