Wang Yuhan, Zhou Beini, Yue Wuriliga, Wang Mengcan, Hu Ke
Department of Respiratory and Critical Care Medicine, Renmin Hospital of Wuhan University, Wuhan, China.
Front Nutr. 2025 Aug 20;12:1619371. doi: 10.3389/fnut.2025.1619371. eCollection 2025.
Obstructive sleep apnea (OSA) is associated with glucose and lipid disturbances and insulin resistance. However, glucose and lipid disturbances and insulin resistance in OSA are often attributed to confounding obesity and/or diabetes. Studies on nondiabetic, nonobese OSA patients are very limited.
This cross-sectional study retrospectively analyzed non-diabetic, non-obese adults who underwent a home sleep apnea testing and collected fasting blood samples before or after the sleep study to measure glucose and lipids. This study was designed as a cross-sectional study and therefore can only demonstrate associations between variables, but not causality.
Among the 191 participants (mean age 48.94 years, 68.06% male) included in the study, 83.77% had OSA. The high-density lipoprotein cholesterol (HDL-C) level in OSA participants was significantly lower (0.99 vs. 1.12 mmol/L, = 0.036), and the triglyceride-glucose (TyG) index was significantly higher (8.74 vs. 8.45, = 0.016), while there was no significant difference in the levels of total cholesterol, low-density lipoprotein cholesterol (LDL-C), and non-HDL-C. Correlation analysis by sex showed that AHI was significantly positively correlated with fasting plasma glucose ( = 0.373), non-HDL-C ( = 0.280), and TyG index ( = 0.337) in female participants, while AHI was only significantly negatively correlated with HDL-C ( = -0.194) in male participants. Multivariable analysis revealed that compared with non-OSA individuals, OSA severity in women was independently associated with fasting plasma glucose (AHI ≥ 5: = 0.55, 95 % CI 0.13 to 0.98; AHI ≥ 15: = 0.60, 95% CI 0.13 to 1.07) and TyG index (AHI ≥ 5: = 0.37, 95% CI 0.08 to 0.66; AHI ≥ 15: = 0.39, 95% CI 0.07 to 0.71; AHI ≥ 30: = 0.53, 95% CI 0.08 to 0.98). In contrast, among men, OSA severity showed independent associations with triglycerides (15 ≤ AHI < 30: = 1.00, 95% CI 0.05 to 1.95) and HDL-C (AHI ≥ 15: = -0.17, 95% CI -0.33 to -0.01; AHI ≥ 30: = -0.22, 95% CI -0.38 to -0.06).
Our study supports the claim that there are sex differences in glucose and lipid metabolic disorders in non-diabetic, non-obese OSA participants: women mainly showed elevated fasting plasma glucose and TyG index, while men showed dyslipidemia with elevated triglycerides and decreased HDL-C. These findings highlight the need to consider sex differences when assessing OSA-related metabolic risks.
阻塞性睡眠呼吸暂停（OSA）与血糖和血脂紊乱以及胰岛素抵抗有关。然而，OSA患者的血糖和血脂紊乱以及胰岛素抵抗往往归因于混杂因素肥胖和/或糖尿病。对非糖尿病、非肥胖OSA患者的研究非常有限。
这项横断面研究回顾性分析了接受家庭睡眠呼吸暂停检测的非糖尿病、非肥胖成年人，并在睡眠研究前后采集空腹血样以测量血糖和血脂。本研究设计为横断面研究，因此只能证明变量之间的关联，而不能证明因果关系。
在纳入研究的191名参与者（平均年龄48.94岁，68.06%为男性）中，83.77%患有OSA。OSA参与者的高密度脂蛋白胆固醇（HDL-C）水平显著较低（0.99对1.12 mmol/L，P = 0.036），甘油三酯-葡萄糖（TyG）指数显著较高（8.74对8.45，P = 0.016），而总胆固醇、低密度脂蛋白胆固醇（LDL-C）和非HDL-C水平无显著差异。按性别进行的相关性分析表明，女性参与者中呼吸暂停低通气指数（AHI）与空腹血糖（P = 0.373）、非HDL-C（P = 0.280）和TyG指数（P = 0.337）显著正相关，而男性参与者中AHI仅与HDL-C显著负相关（P = -0.194）。多变量分析显示，与非OSA个体相比，女性的OSA严重程度与空腹血糖独立相关（AHI≥5：P = 0.55，95%CI 0.13至0.98；AHI≥15：P = 0.60，95%CI 0.13至1.07）和TyG指数（AHI≥5：P = 0.37，95%CI 0.08至0.66；AHI≥15：P = 0.39，95%CI 0.07至0.71；AHI≥30：P = 0.53，95%CI 0.08至0.98）。相比之下，在男性中，OSA严重程度与甘油三酯（15≤AHI<30：P = 1.00，95%CI 0.05至1.95）和HDL-C（AHI≥15：P = -0.17，95%CI -0.33至-0.01；AHI≥30：P = -0.22，95%CI -0.38至-0.06）独立相关。
我们的研究支持以下观点，即在非糖尿病、非肥胖OSA参与者中，血糖和脂质代谢紊乱存在性别差异：女性主要表现为空腹血糖和TyG指数升高，而男性表现为血脂异常，甘油三酯升高和HDL-C降低。这些发现突出了在评估OSA相关代谢风险时考虑性别差异的必要性。
