HIF1A and obstructive sleep apnea syndrome: Critically, these metabolic alterations interact with respiratory and systemic conditions: Hyperinsulinemia exacerbates obstructive sleep apnea (OSA) by increasing upper airway collapsibility, while OSA-related nocturnal hypoxia further worsens insulin resistance via HIF-1α activation, creating a vicious cycle that amplifies asthma risk (61).