Chen Lvao, Chen Jiuming, Chen Shikai, Cui Yingchao
Department of Laboratory Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine. No, 197 Second Ruijin Road, Shanghai, 200025, China.
BMC Public Health. 2025 May 29;25(1):1987. doi: 10.1186/s12889-025-23274-2.
The ratio of the non-HDL-cholesterol to HDL- cholesterol (NHHR) is a newly proposed lipid metric. Currently, few studies have explored the relationship between NHHR and obstructive sleep apnea (OSA) among middle-aged and elderly people. This study aims to investigate the potential association between NHHR and OSA.
This study included participants from the NHANES 2015-2018 cycles, focusing exclusively on individuals aged 40 and above. OSA data were estimated based on questionnaire responses. NHHR was estimated as the ratio of non-HDL-C to HDL-C. Multivariable logistic regression, adjusted for covariates, subgroup analysis, and smoothing spline fittings were utilized to assess the link between NHHR and OSA.
A total of 5,858 participants were analyzed. Multivariable logistic regression highlighted a statistically significant positive relationship between NHHR and OSA [OR 1.06 (95% CI: 1.02, 1.11), p = 0.0053]. As NHHR increased by tertiles, the risk of OSA also showed an upward trend. Subgroup and interaction analyses confirmed the overall association was robust across most confounding factors except for gender and diabetes status. Further nonlinear analyses identified a significant inverted U-shaped curve (p-nonlinearity < 0.05) with peak risk at an NHHR of 5.3. This pattern was particularly evident in males (turning point = 3.97) and diabetics (turning point = 5.61).
From 2015 to 2018, among the NHANES population aged over 40, NHHR showed a significant and independent positive association with OSA risk. The consistency of this relationship across various subgroups suggests NHHR's potential as a complementary biomarker for metabolic risk assessment in OSA.
非高密度脂蛋白胆固醇与高密度脂蛋白胆固醇的比值（NHHR）是一种新提出的血脂指标。目前，很少有研究探讨中老年人中NHHR与阻塞性睡眠呼吸暂停（OSA）之间的关系。本研究旨在调查NHHR与OSA之间的潜在关联。
本研究纳入了2015 - 2018年美国国家健康与营养检查调查（NHANES）周期的参与者，仅关注40岁及以上的个体。OSA数据根据问卷回答进行估算。NHHR被估算为非高密度脂蛋白胆固醇（non-HDL-C）与高密度脂蛋白胆固醇（HDL-C）的比值。采用多变量逻辑回归，并对协变量进行调整，进行亚组分析和平滑样条拟合，以评估NHHR与OSA之间的联系。
共分析了5858名参与者。多变量逻辑回归显示NHHR与OSA之间存在统计学上显著的正相关关系[比值比（OR）为1.06（95%置信区间：1.02，1.11），p = 0.0053]。随着NHHR按三分位数增加，OSA的风险也呈上升趋势。亚组和交互分析证实，除性别和糖尿病状态外，总体关联在大多数混杂因素中都很稳健。进一步的非线性分析发现了一条显著的倒U形曲线（p-非线性<0.05），在NHHR为5.3时风险最高。这种模式在男性（转折点 = 3.97）和糖尿病患者（转折点 = 5.61）中尤为明显。
在2015年至2018年期间，在NHANES中40岁以上人群中，NHHR与OSA风险呈现出显著且独立的正相关关系。这种关系在各个亚组中的一致性表明NHHR作为OSA代谢风险评估的补充生物标志物的潜力。
