{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,7]],"date-time":"2026-03-07T02:03:14Z","timestamp":1772848994975,"version":"3.50.1"},"reference-count":46,"publisher":"MDPI AG","issue":"4","license":[{"start":{"date-parts":[[2022,4,12]],"date-time":"2022-04-12T00:00:00Z","timestamp":1649721600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100005642","name":"University of Sassari","doi-asserted-by":"publisher","award":["Fondo di Ateneo per la Ricerca: annualit\u00e0 2020"],"award-info":[{"award-number":["Fondo di Ateneo per la Ricerca: annualit\u00e0 2020"]}],"id":[{"id":"10.13039\/501100005642","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100003407","name":"Ministry of Education, Universities and Research","doi-asserted-by":"publisher","award":["Programma Operativo Nazionale (PON) Ricerca e Innovazione 2014\u20132020\u201d, Asse I \u201cCapitale Umano,\u201d Azione I.2 A.I.M, Attrazione e mobilita dei ricercatori, Linea 1 (Mobilit\u00e0 dei Ricerca-tori)"],"award-info":[{"award-number":["Programma Operativo Nazionale (PON) Ricerca e Innovazione 2014\u20132020\u201d, Asse I \u201cCapitale Umano,\u201d Azione I.2 A.I.M, Attrazione e mobilita dei ricercatori, Linea 1 (Mobilit\u00e0 dei Ricerca-tori)"]}],"id":[{"id":"10.13039\/501100003407","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Antioxidants"],"abstract":"<jats:p>Obstructive sleep apnoea (OSA) is characterized by overproduction of reactive oxygen species and oxidative stress. The antioxidant enzyme paraoxonase-1 (PON-1) may be useful for monitoring the antioxidant defence systems and the effect of treatments in OSA patients. We investigated, by means of systematic review and meta-analysis, the serum concentrations of PON-1 in OSA patients and non-OSA controls. A literature search was conducted in PubMed, Web of Science, Scopus and Google Scholar databases, from the outset to November 2021, utilizing the terms: \u201cparaoxonase\u201d or \u201cPON\u201d or \u201cparaoxonase-1\u201d or \u201cPON-1\u201d and \u201cobstructive sleep apnoea syndrome\u201d or \u201cOSAS\u201d or \u201cOSA\u201d. Eleven studies in 429 OSA patients and 258 non-OSA controls were involved in the meta-analysis. The pooled serum PON-1 concentrations were significantly lower in OSA (standardized mean difference (SMD) = \u22120.70, 95% CI \u22121.13 to \u22120.28; p = 0.001). Despite the extreme between-study heterogeneity, the SMD values were not substantially affected by the sequential omission of individual studies. There was no publication bias. Our systematic review and meta-analysis supports the presence of an impaired antioxidant defence system in OSA, possibly the consequence of intermittent hypoxia. Further studies are required to determine the clinical use of PON-1 measurements for risk stratification and monitoring in OSA patients.<\/jats:p>","DOI":"10.3390\/antiox11040766","type":"journal-article","created":{"date-parts":[[2022,4,12]],"date-time":"2022-04-12T21:15:35Z","timestamp":1649798135000},"page":"766","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Paraoxonase-1 Concentrations in Obstructive Sleep Apnoea: A Systematic Review and Meta-Analysis"],"prefix":"10.3390","volume":"11","author":[{"given":"Maria Carmina","family":"Pau","sequence":"first","affiliation":[{"name":"Department of Medical, Surgical and Experimental Sciences, University of Sassari, 07100 Sassari, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8396-0968","authenticated-orcid":false,"given":"Angelo","family":"Zinellu","sequence":"additional","affiliation":[{"name":"Department of Biomedical Sciences, University of Sassari, 07100 Sassari, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Elisabetta","family":"Zinellu","sequence":"additional","affiliation":[{"name":"Clinical and Interventional Pneumology, University Hospital Sassari (AOU), 07100 Sassari, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3031-7733","authenticated-orcid":false,"given":"Gianfranco","family":"Pintus","sequence":"additional","affiliation":[{"name":"Department of Biomedical Sciences, University of Sassari, 07100 Sassari, Italy"},{"name":"Department of Medical Laboratory Sciences, Sharjah Institute for Medical Research, College of Health Sciences, University of Sharjah, Sharjah 27272, United Arab Emirates"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6985-4907","authenticated-orcid":false,"given":"Ciriaco","family":"Carru","sequence":"additional","affiliation":[{"name":"Department of Biomedical Sciences, University of Sassari, 07100 Sassari, Italy"},{"name":"Quality Control Unit, University Hospital of Sassari (AOU), Viale San Pietro, 07100 Sassari, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5330-572X","authenticated-orcid":false,"given":"Alessandro G.","family":"Fois","sequence":"additional","affiliation":[{"name":"Department of Medical, Surgical and Experimental Sciences, University of Sassari, 07100 Sassari, Italy"},{"name":"Clinical and Interventional Pneumology, University Hospital Sassari (AOU), 07100 Sassari, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8699-1412","authenticated-orcid":false,"given":"Arduino A.","family":"Mangoni","sequence":"additional","affiliation":[{"name":"Flinders Medical Centre, Department of Clinical Pharmacology, College of Medicine and Public Health, Flinders University, Bedford Park, SA 5042, Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1457-8025","authenticated-orcid":false,"given":"Pietro","family":"Pirina","sequence":"additional","affiliation":[{"name":"Department of Medical, Surgical and Experimental Sciences, University of Sassari, 07100 Sassari, Italy"},{"name":"Clinical and Interventional Pneumology, University Hospital Sassari (AOU), 07100 Sassari, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2022,4,12]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"325","DOI":"10.1378\/chest.07-0040","article-title":"Adult obstructive sleep apnea: Pathophysiology and diagnosis","volume":"132","author":"Patil","year":"2007","journal-title":"Chest"},{"key":"ref_2","doi-asserted-by":"crossref","unstructured":"Mochol, J., Gawrys, J., Gajecki, D., Szahidewicz-Krupska, E., Martynowicz, H., and Doroszko, A. (2021). Cardiovascular Disorders Triggered by Obstructive Sleep Apnea-A Focus on Endothelium and Blood Components. Int. J. Mol. Sci., 22.","DOI":"10.3390\/ijms22105139"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"e010440","DOI":"10.1161\/JAHA.118.010440","article-title":"Obstructive Sleep Apnea in Cardiovascular Disease: A Review of the Literature and Proposed Multidisciplinary Clinical Management Strategy","volume":"8","author":"Tietjens","year":"2019","journal-title":"J. Am. Heart Assoc."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"303","DOI":"10.1016\/j.pcad.2008.08.003","article-title":"Oxidative stress--a unifying paradigm in obstructive sleep apnea and comorbidities","volume":"51","author":"Lavie","year":"2009","journal-title":"Prog. Cardiovasc. Dis."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"4982324","DOI":"10.1155\/2020\/4982324","article-title":"Reliability and Usefulness of Different Biomarkers of Oxidative Stress in Chronic Obstructive Pulmonary Disease","volume":"2020","author":"Zinellu","year":"2020","journal-title":"Oxid. Med. Cell Longev."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"22","DOI":"10.4103\/jcrt.JCRT_862_16","article-title":"Oxidative stress and its role in cancer","volume":"17","author":"Jelic","year":"2021","journal-title":"J. Cancer Res. Ther."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"65","DOI":"10.1016\/B978-0-12-405211-6.00003-6","article-title":"Paraoxonases: Ancient substrate hunters and their evolving role in ischemic heart disease","volume":"59","author":"Martinelli","year":"2013","journal-title":"Adv. Clin. Chem."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1016\/j.cca.2009.09.025","article-title":"Paraoxonase: A multifaceted biomolecule","volume":"410","author":"Goswami","year":"2009","journal-title":"Clin. Chim. Acta"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"20","DOI":"10.1016\/j.atherosclerosis.2010.08.076","article-title":"The three-gene paraoxonase family: Physiologic roles, actions and regulation","volume":"214","author":"Amre","year":"2011","journal-title":"Atherosclerosis"},{"key":"ref_10","doi-asserted-by":"crossref","unstructured":"Ceron, J.J., Tecles, F., and Tvarijonaviciute, A. (2014). Serum paraoxonase 1 (PON-1) measurement: An update. BMC Vet. Res., 10.","DOI":"10.1186\/1746-6148-10-74"},{"key":"ref_11","doi-asserted-by":"crossref","unstructured":"Taler-Ver\u010di\u010d, A., Goli\u010dnik, M., and Bavec, A. (2020). The Structure and Function of Paraoxonase-1 and Its Comparison to Paraoxonase-2 and -3. Molecules, 25.","DOI":"10.3390\/molecules25245980"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"143","DOI":"10.1016\/j.atherosclerosis.2015.12.021","article-title":"Serum paraoxonase-1 activity and risk of incident cardiovascular disease: The PREVEND study and meta-analysis of prospective populationstudies","volume":"245","author":"Kunutsor","year":"2016","journal-title":"Atherosclerosis"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"108067","DOI":"10.1016\/j.diabres.2020.108067","article-title":"Importance of paraoxonase 1 (PON-1) as an antioxidant and antiatherogenic enzyme in the cardiovascular complications of type 2 diabetes: Genotypic and phenotypic evaluation","volume":"161","author":"Shokri","year":"2020","journal-title":"Diabetes Res. Clin. Pract."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"161","DOI":"10.5152\/eurasianjmed.2019.19122","article-title":"Paraoxonase Activity and Phenotype Distribution in Patients with Chronic Obstructive Pulmonary Disease","volume":"52","author":"Sarioglu","year":"2020","journal-title":"Eurasian J. Med."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"365","DOI":"10.1007\/s11325-012-0703-5","article-title":"Lipid peroxidation and paraoxonase activity in nocturnal cyclic and sustained intermittent hypoxia","volume":"17","author":"Okur","year":"2013","journal-title":"Sleep Breath"},{"key":"ref_16","first-page":"123","article-title":"Evidence for lipid peroxidation in obstructive sleep apnea","volume":"27","author":"Lavie","year":"2004","journal-title":"Sleep"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"3390","DOI":"10.1210\/jc.2013-3939","article-title":"Impairment of high-density lipoprotein resistance to lipid peroxidation and adipose tissue inflammation in obesity complicated by obstructive sleep apnea","volume":"99","author":"Yadav","year":"2014","journal-title":"J. Clin. Endocrinol. Metab."},{"key":"ref_18","unstructured":"Aromataris, E., and Munn, Z. (2020). Chapter 7: Systematic Reviews of Etiology and Risk. Joanna Briggs Institute Reviewer\u2019s Manual for Evidence Synthesis, The Joanna Briggs Institute. Available online: https:\/\/reviewersmanual.joannabriggs.org\/."},{"key":"ref_19","unstructured":"Cohen, J. (1988). Statistical Power Analysis for the Behavioral Sciences, Erlbaum. [2nd ed.]."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"4","DOI":"10.1016\/j.jclinepi.2017.05.006","article-title":"The GRADE Working Group clarifies the construct of certainty of evidence","volume":"87","author":"Hultcrantz","year":"2017","journal-title":"J. Clin. Epidemiol."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"83","DOI":"10.1016\/j.jclinepi.2018.05.011","article-title":"GRADE guidelines: 20. Assessing the certainty of evidence in the importance of outcomes or values and preferences-inconsistency, imprecision, and other domains","volume":"111","author":"Zhang","year":"2019","journal-title":"J. Clin. Epidemiol."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"n71","DOI":"10.1136\/bmj.n71","article-title":"The PRISMA 2020 statement: An updated guideline for reporting systematic reviews","volume":"372","author":"Page","year":"2021","journal-title":"BMJ"},{"key":"ref_23","doi-asserted-by":"crossref","unstructured":"Wan, X., Wang, W., Liu, J., and Tong, T. (2014). Estimating the sample mean and standard deviation from the sample size, median, range and\/or interquartile range. BMC Med. Res. Methodol, 14.","DOI":"10.1186\/1471-2288-14-135"},{"key":"ref_24","doi-asserted-by":"crossref","unstructured":"Bowden, J., Tierney, J.F., Copas, A.J., and Burdett, S. (2011). Quantifying, displaying and accounting for heterogeneity in the meta-analysis of RCTs using standard and generalised Q statistics. BMC Med. Res. Methodol., 11.","DOI":"10.1186\/1471-2288-11-41"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"1539","DOI":"10.1002\/sim.1186","article-title":"Quantifying heterogeneity in a meta-analysis","volume":"21","author":"Higgins","year":"2002","journal-title":"Stat. Med."},{"key":"ref_26","first-page":"15","article-title":"Assessing the influence of a single study in the meta-analysis estimate","volume":"47","author":"Tobias","year":"1999","journal-title":"Stata Tech. Bull."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"1088","DOI":"10.2307\/2533446","article-title":"Operating characteristics of a rank correlation test for publication bias","volume":"50","author":"Begg","year":"1994","journal-title":"Biometrics"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"1046","DOI":"10.1016\/S0895-4356(01)00377-8","article-title":"Funnel plots for detecting bias in meta-analysis: Guidelines on choice of axis","volume":"54","author":"Sterne","year":"2001","journal-title":"J. Clin. Epidemiol."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"455","DOI":"10.1111\/j.0006-341X.2000.00455.x","article-title":"Trim and fill: A simple funnel-plot-based method of testing and adjusting for publication bias in meta-analysis","volume":"56","author":"Duval","year":"2000","journal-title":"Biometrics"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"100","DOI":"10.1111\/j.1479-8425.2007.00259.x","article-title":"Oxidative stress and systemic inflammation in patients with sleep apnea: Role of obesity","volume":"5","author":"Lavie","year":"2007","journal-title":"Sleep Biol. Rhythm."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"184","DOI":"10.1016\/j.cca.2008.04.023","article-title":"Reduced paraoxonase 1\/arylesterase activity and its post-therapeutic increase in obstructive sleep apnea syndrome: A preliminary study","volume":"395","author":"Kotani","year":"2008","journal-title":"Clin. Chim. Acta"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"313","DOI":"10.1111\/j.1365-2869.2008.00725.x","article-title":"Increase in serum haptoglobin and apolipoprotein M in patients with obstructive sleep apnoea","volume":"18","author":"Kim","year":"2009","journal-title":"J. Sleep Res."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"139","DOI":"10.1111\/j.1365-2869.2009.00789.x","article-title":"Heat-shock protein 70: Expression in monocytes of patients with sleep apnoea and association with oxidative stress and tumour necrosis factor-alpha","volume":"19","author":"Lavie","year":"2010","journal-title":"J. Sleep Res."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"275","DOI":"10.1007\/s11325-010-0378-8","article-title":"Obstructive sleep apnea causes oxidative damage to plasma lipids and proteins and decreases adiponectin levels","volume":"15","author":"Vatansever","year":"2011","journal-title":"Sleep Breath"},{"key":"ref_35","first-page":"770","article-title":"Serum paraoxonase, arylesterase activity and oxidative status in patients with obstructive sleep apnea syndrome (OSAS)","volume":"16","author":"Baysal","year":"2012","journal-title":"Eur. Rev. Med. Pharmacol. Sci."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"3","DOI":"10.1186\/s12931-015-0166-x","article-title":"Sleepiness, inflammation and oxidative stress markers in middle-aged males with obstructive sleep apnea without metabolic syndrome: A cross-sectional study","volume":"16","author":"Andaku","year":"2015","journal-title":"Respir. Res."},{"key":"ref_37","first-page":"56","article-title":"Increased oxidative stress and reduced antioxidant enzyme activity in obstructive sleep apnea syndrome","volume":"2","author":"Ismailogullari","year":"2016","journal-title":"ISJMS"},{"key":"ref_38","first-page":"17","article-title":"Paraoxonase 1 Gene L55M Polymorphism and Paraoxonase 1 Activity in Obstructive Sleep Apnea Patients","volume":"1150","author":"Baszczuk","year":"2019","journal-title":"Adv. Exp. Med. Biol."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"608438","DOI":"10.1155\/2015\/608438","article-title":"Obstructive Sleep Apnea, Oxidative Stress, and Cardiovascular Disease: Evidence from Human Studies","volume":"2015","author":"Eisele","year":"2015","journal-title":"Oxid. Med. Cell Longev."},{"key":"ref_40","doi-asserted-by":"crossref","unstructured":"Maniaci, A., Iannella, G., Cocuzza, S., Vicini, C., Magliulo, G., Ferlito, S., Cammaroto, G., Meccariello, G., De Vito, A., and Nicolai, A. (2021). Oxidative Stress and Inflammation Biomarker Expression in Obstructive Sleep Apnea Patients. J. Clin. Med., 10.","DOI":"10.3390\/jcm10020277"},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"1683","DOI":"10.1016\/j.freeradbiomed.2006.01.008","article-title":"Oxidative stress and oxidant signaling in obstructive sleep apnea and associated cardiovascular diseases","volume":"40","author":"Suzuki","year":"2006","journal-title":"Free Radic. Biol. Med."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"2429","DOI":"10.1016\/j.jacc.2006.01.074","article-title":"Association of paraoxonase-1 activity and concentration with angiographic severity and extent of coronary artery disease","volume":"47","author":"James","year":"2006","journal-title":"J. Am. Coll Cardiol."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"225","DOI":"10.1016\/S0008-6363(02)00659-4","article-title":"Paraoxonase-1 reduces monocyte chemotaxis and adhesion to endothelial cells due to oxidation of palmitoyl, linoleoyl glycerophosphorylcholine","volume":"57","author":"Ahmed","year":"2003","journal-title":"Cardiovasc Res."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"241","DOI":"10.2217\/fca.10.123","article-title":"Vascular changes, cardiovascular disease and obstructive sleep apnea","volume":"7","author":"Ramar","year":"2011","journal-title":"Future Cardiol"},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"137","DOI":"10.2147\/VHRM.S165173","article-title":"Paraoxonase (PON)-1: A brief overview on genetics, structure, polymorphisms and clinical relevance","volume":"14","author":"Shunmoogam","year":"2018","journal-title":"Vasc. Health Risk Manag."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"25","DOI":"10.1007\/s42399-019-00202-1","article-title":"Paraoxonase Activity in Patients with Obstructive Sleep Apnea: A Systematic Review and Meta-analysis","volume":"2","author":"Fadaei","year":"2020","journal-title":"SN Comp. Clin. Med."}],"container-title":["Antioxidants"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2076-3921\/11\/4\/766\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T22:52:39Z","timestamp":1760136759000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2076-3921\/11\/4\/766"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,4,12]]},"references-count":46,"journal-issue":{"issue":"4","published-online":{"date-parts":[[2022,4]]}},"alternative-id":["antiox11040766"],"URL":"https:\/\/doi.org\/10.3390\/antiox11040766","relation":{},"ISSN":["2076-3921"],"issn-type":[{"value":"2076-3921","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,4,12]]}}}