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). This evidence concerns the gene HIF1A and hyperinsulinism.