Independent Association Between Nocturnal Intermittent Hypoxemia and Metabolic Dyslipidemia

Background There is growing evidence from animal models that intermittent hypoxemia (IH) may induce dyslipidemia. Altered lipid metabolism may contribute to the increased cardiovascular risk observed in obstructive sleep apnea (OSA). In this multisite, cross-sectional study, we tested the hypothesis that there is an independent association between nocturnal IH and dyslipidemia in OSA. Methods Fasting serum lipid levels were measured in 2,081 patients (638 women) undergoing nocturnal recording for clinical suspicion of OSA. Multivariate regression analyses were performed to evaluate the independent associations between oxygen desaturation index (ODI) and lipid profile after adjustment for potential confounders, including components of the metabolic syndrome (MS) or the MS itself. Adjusted OR for metabolic dyslipidemia (triglycerides [TG] ≥ 150 mg/dL and high-density lipoprotein cholesterol [HDL-C] ≤ 50 mg/dL for women and ≤ 40 mg/dL for men) according to quartiles of ODI were determined by logistic regression. Results Total cholesterol and low-density lipoprotein cholesterol were not associated with ODI. In contrast, nocturnal IH and OSA severity were associated with higher TG levels and lower HDL-C levels after adjustment for confounding factors. The association between ODI and TG and HDL-C levels was independent of the MS. Adjusted OR (95% CIs) for metabolic dyslipidemia were 1 (reference), 1.56 (1.24-1.96), 1.72 (1.29-2.29), and 1.93 (1.55-2.41) for ODI ≤ 7, > 7 to ≤ 18, > 18 to ≤ 38, and > 38, respectively (P <.0001 for linear trend). Conclusions Nocturnal IH is independently associated with metabolic dyslipidemia, which may predispose patients with OSA to a higher risk of cardiovascular disease.