Additionally, OSA exacerbates vascular damage by synergistically amplifying inflammatory signaling pathways: under sleep deprivation and IH, TLRs on macrophages are activated, inducing the release of pro-inflammatory cytokines and chemokines like TNF-α, IL-1, and IL-6, which cause endothelial dysfunction and initiate atherosclerosis (94). Here, TNF is linked to obstructive sleep apnea syndrome.