TNF and Sleep apnea: Additional abnormalities consist of dysregulation of adipocytokines, depleted mitochondrial ATP, production of toxic uric acid, periodic hypoxia (i.e., during sleep apnea in extremely obese patients), and toxic products from gut microbiome which include tumor necrosis factor (TNF)-α, endogenous ethanol, and endotoxins like lipopolysaccharides (LPS).