Frontiers in Nutrition · 12 authors, 11 centres
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This cross-sectional study of 10,826 Chinese adults found that higher HDL-cholesterol was associated with a lower risk of obstructive sleep apnea (OSA), while elevated triglycerides and fasting blood glucose were associated with a higher risk. No significant associations were found for LDL-cholesterol or total cholesterol. The findings suggest that maintaining healthy glycolipid metabolism may be important for OSA prevention.
**Background:** Obstructive sleep apnea (OSA) is a common sleep disorder affecting approximately 1 billion adults worldwide. Previous studies have suggested associations between glycolipid biomarkers and OSA, but results have been inconsistent. This study aimed to investigate associations between multiple glycolipid biomarkers (HDL-CH, LDL-CH, TC, TG, FBG) and OSA risk in a large Chinese population.
**Methods:** This cross-sectional study included 10,826 participants aged 35-74 years from the baseline survey of the Guangzhou Heart Study (GZHS), recruited between July 2015 and August 2017 using randomized multistage cluster sampling. OSA was ascertained using both the Berlin Questionnaire (BQ) and STOP-BANG Questionnaire (SBQ). Participants high-risk on both were classified as OSA (8.22%), low-risk on both as non-OSA (76.22%), and the remainder as pre-OSA (15.56%). Fasting blood samples were collected and HDL-CH, LDL-CH, TC, TG, and FBG were measured. Multivariate logistic regression was used to calculate odds ratios (OR) with 95% confidence intervals (CI) after adjusting for age, sex, BMI, waist-hip ratio, smoking, alcohol, physical activity, education, marital status, work intensity, fruit/vegetable intake, PM2.5 exposure, hypertension, dyslipidemia, diabetes, COPD, and CVDs.
**Key Results:** When comparing highest vs. lowest quartiles, HDL-CH was associated with a 22% reduced risk of pre-OSA (OR: 0.78, 95% CI: 0.65-0.94) and 41% reduced risk of OSA (OR: 0.59, 95% CI: 0.45-0.78). Triglyceride was associated with a 32% increased risk of pre-OSA (OR: 1.32, 95% CI: 1.08-1.60) and 56% increased risk of OSA (OR: 1.56, 95% CI: 1.18-2.07). FBG was associated with a 37% increased risk of pre-OSA (OR: 1.37, 95% CI: 1.13-1.67) and 38% increased risk of OSA (OR: 1.38, 95% CI: 1.03-1.85). Significant exposure-response trends were observed for HDL-CH, TG, and FBG with both pre-OSA and OSA (all p<0.05). No significant associations were found for LDL-CH or TC. Sensitivity analyses excluding participants with COPD and CVDs yielded similar results. Dyslipidemia and diabetes were not significantly associated with OSA after adjustment.
**Clinical Implications:** This study suggests that HDL-CH is inversely associated with OSA risk, while elevated TG and FBG are positively associated with OSA risk, independent of obesity and other confounders. Notably, even FBG levels below the diabetes threshold (>5.68 mmol/L) were associated with increased OSA risk. These findings highlight the importance of monitoring glycolipid metabolism for OSA prevention. However, causality cannot be inferred due to the cross-sectional design, and OSA was defined by questionnaires rather than polysomnography, which is a limitation. Longitudinal studies are needed to confirm these relationships.