Stable reference genes for 24-hour circadian profiling of core clock genes in the blood of obstructive sleep apnea patients

Obstructive sleep apnea (OSA), one of the most common breathing disorders during sleep, is associated with circadian rhythm disruption, yet circadian genes expressed in blood remain largely unexplored as biomarkers. Reliable circadian gene expression analysis requires stable reference genes for qRT-PCR normalization, but no clear guidance exists for blood-based circadian studies in OSA. We evaluated the expression of 11 candidate reference genes (GAPDH, ACTB, RPL13A, PPIB, TBP, HPRT1, PPIA, SDHA, TUBB2A, UBC) in whole blood collected every 6 hours over 24 hours from 40 participants who underwent overnight respiratory polygraphy. Gene stability was assessed with RefFinder and EndoGeneAnalyzer across OSA severity levels, intra-individual variability, and time-point variability. ACTB and RPL13A consistently emerged as the most stable reference genes under all conditions. Their robustness was confirmed by personalized cosinor analysis of core clock genes (BMAL1, PER2, CRY1), showing that reliable normalization enables detection of circadian oscillations in clinical samples. While population-level analysis revealed no significant rhythmicity, individual profiles showed oscillations in 25 participants, independent of OSA severity. These findings identify ACTB and RPL13A as strong candidates for circadian transcriptomic studies in blood and provide a methodological foundation for biomarker discovery in sleep medicine, molecular medicine, and translational chronobiology.