Liu Yu, Li Liang, Wang Ruixue, Guo Shucen, Shen Yitong, Yue Bowen, Zhu Wenjing, Zheng Cuixia
Department of Respiratory and Critical Care Medicine, Yangpu Hospital, School of Medicine, Tongji University, 450 Tengyue Road, Shanghai, 200090, China.
Eur J Med Res. 2025 Jul 2;30(1):565. doi: 10.1186/s40001-025-02728-8.
Emerging evidence highlights interactions between obstructive sleep apnea (OSA), lipid metabolism, and inflammation, yet the associations bridging inflammatory processes to metabolic dysregulation in OSA remain poorly defined. This study evaluates the uric acid-to-high-density lipoprotein cholesterol ratio (UHR)-a novel composite metabolic-lipid biomarker-and C-reactive protein (CRP), a classical inflammatory marker, to elucidate their associations with OSA and potential mediating pathways.
Using data from the National Health and Nutrition Examination Survey (NHANES), we performed weighted multivariable logistic regression to examine associations of UHR and CRP with OSA. Nonlinear relationships were assessed via restricted cubic splines (RCS), and mediation analysis quantified CRP's role in linking UHR to OSA. Subgroup and sensitivity analyses tested result robustness.
Among 14,815 participants (7538 OSA cases), higher UHR levels showed a positive correlation with OSA prevalence in fully adjusted cross-sectional analyses. Specifically, the highest vs. lowest UHR quartile was correlated with 31% higher odds of OSA (OR = 1.31, 95% CI 1.15-1.49, P < 0.001). A similar pattern was observed for CRP, where elevated levels corresponded to 32% greater odds of OSA (OR = 1.32, 95% CI 1.18-1.47, P < 0.001). RCS analysis revealed a nonlinear dose-response relationship between UHR and OSA (P for nonlinear < 0.001), characterized by an inverted L-shaped curve with steeper risk elevation at lower UHR values and stabilization at higher levels. CRP accounted for 17.7% of the observed association between UHR and OSA (P < 0.001). Stratified and sensitivity analyses confirmed consistency across subgroups.
Elevated UHR levels were independently associated with OSA risk in this cross-sectional cohort, highlighting its potential as a clinical biomarker. The partial mediation role of CRP may reflect underlying pathways linking metabolic dysregulation and inflammation in OSA.
新出现的证据突显了阻塞性睡眠呼吸暂停（OSA）、脂质代谢和炎症之间的相互作用，但OSA中连接炎症过程与代谢失调的关联仍未明确界定。本研究评估尿酸与高密度脂蛋白胆固醇比值（UHR）——一种新型复合代谢 - 脂质生物标志物——以及经典炎症标志物C反应蛋白（CRP），以阐明它们与OSA的关联及潜在的介导途径。
利用美国国家健康与营养检查调查（NHANES）的数据，我们进行加权多变量逻辑回归，以检验UHR和CRP与OSA的关联。通过受限立方样条（RCS）评估非线性关系，并进行中介分析以量化CRP在将UHR与OSA联系起来的作用。亚组分析和敏感性分析检验结果的稳健性。
在14,815名参与者（7538例OSA病例）中，在完全调整的横断面分析中，较高的UHR水平与OSA患病率呈正相关。具体而言，UHR四分位数最高组与最低组相比，OSA的患病几率高31%（OR = 1.31，95% CI 1.15 - 1.49，P < 0.001）。CRP也观察到类似模式，其水平升高对应OSA患病几率高32%（OR = 1.32，95% CI 1.18 - 1.47，P < 0.001）。RCS分析显示UHR与OSA之间存在非线性剂量反应关系（非线性P < 0.001），其特征为倒L形曲线，在较低UHR值时风险升高更陡峭，在较高水平时趋于稳定。CRP占UHR与OSA之间观察到的关联的17.7%（P < 0.001）。分层分析和敏感性分析证实各亚组结果具有一致性。
在这个横断面队列中，UHR水平升高与OSA风险独立相关，突显了其作为临床生物标志物的潜力。CRP的部分中介作用可能反映了OSA中连接代谢失调与炎症的潜在途径。
