0478 The Association of Obstructive Sleep Apnea with Metabolic Syndrome Is Modified by Age

Abstract Introduction It has been proposed that there is a bi-directional, feed forward, pernicious association between obstructive sleep apnea (OSA) and metabolic syndrome, all promoting atherosclerosis and cardiovascular disease. However, the cardiometabolic comorbidities associated with OSA tend to diminish with age. The goal of this study is to examine whether the association of OSA with MetS is modified by age. Methods We studied 1,741 adults from the Penn State Adult Cohort (age 20-88 years, 52.3% female, 12.4% racial/ethnic minority) who underwent a 1-night polysomnographic evaluation, clinical history, and physical examination. The presence of OSA was defined as an apnea/hypopnea index ≥15 events/hour. Outcome variables include the five MetS components as defined by the National Heart, Lung, and Blood Institute/American Heart Association modified criteria, i.e., obesity (BMI≥30 kg/m2), hypercholesterolemia (≥200 mg/dL), hypertriglyceridemia (≥150 mg/dL), diabetes (fasting glucose ≥100 mg/dL and/or treatment), and hypertension (blood pressure ≥130/85 mm Hg and/or treatment). Logistic regression models examined the association of OSA with MetS components in the entire cohort and divided by age ( 60 and ≥ 60 years) adjusting for race, sex, smoking, alcohol and sampling weight. Results There was a significant interaction between MetS components and age. In individuals younger than 60 years old, OSA was significantly associated with increased risk of diabetes (OR=5.619, 95%CI=2.74-11.53, p=.001), hypertension (OR=3.85, 95%CI= 1.95-7.63, p=.001), hypercholesterolemia (OR=5.99, 95%CI=2.36-15.21) and hypertriglyceridemia (OR=4.75,95%CI=2.30-9.90, p=.001). There was no association of OSA and these four components of MetS syndrome (i.e., hypertension, diabetes, hypercholesterolemia and hypertriglyceridemia) in individuals 60 years or older. The association of OSA with BMI was stronger in those younger than 60 vs. those older than 60 (OR=6.03, 95%CI=3.08-11.78, p.001 vs, 2.47, 95%CI= 1.23-4.94, p=.011, respectively). Conclusion The association of MetS components with OSA is strong in young and middle-aged adults, but not in older adults. These findings suggest that MetS is key to the pathogenesis of OSA in young and middle-aged adults whereas other mechanisms such as airway anatomy and collapsibility play a greater role in older adults. This suggest different treatment strategies may be needed for this highly prevalent sleep-related breathing disorder among different populations. Support (if any)