Obstructive sleep apnea is associated with disturbances in nutrition-related biochemical markers among eutrophic adults: Findings from the EPISONO cohort

Although obstructive sleep apnea (OSA) is strongly linked to obesity, less is known about nutritional and biochemical alterations among eutrophic individuals with the disorder. This study aimed to evaluate nutrition-related biochemical markers in eutrophic adults living in São Paulo and examine their association with OSA severity. This cross-sectional analysis used data from the 4 th edition of the EPISONO, a population-based study. Participants underwent polysomnography, blood sample analysis, and lifestyle questionnaires. From an initial sample of 769 participants, 23.9% were eutrophic adults aged 20-59 years. Participants were classified as no OSA, mild OSA, or moderate-to-severe OSA. The Kruskal-Wallis test and generalized linear models (GzLM) were applied. Individuals with moderate-to-severe OSA exhibited higher concentrations of very-low density lipoprotein (VLDL) and triglycerides compared with those without OSA, while zinc levels differed across OSA severity groups. In the total sample, higher apnea-hypopnea index (AHI) values were independently associated with higher VLDL and triglyceride levels and lower magnesium concentrations after full adjustment. Sex-stratified analyses revealed that lipid markers and zinc were linked to AHI in women, whereas magnesium was inversely associated with AHI in men. These findings suggest that metabolic and nutrition-related differences may coexist with OSA even in individuals within the eutrophic range and may exhibit distinct sex-specific patterns. In eutrophic adults from the 4 th edition of the EPISONO cohort, obstructive sleep apnea (OSA) severity showed significant differences in VLDL, triglycerides, and zinc levels. In generalized linear models (GzLM) using the apnea-hypopnea index (AHI), higher VLDL and triglyceride levels and lower magnesium concentrations were observed in the total sample, independent of adiposity. In sex-stratified analyses, lower magnesium levels were identified in males, while higher VLDL and triglyceride levels, and lower zinc concentrations were observed in females. • Eutrophic adults with obstructive sleep apnea (OSA) show alterations in lipid and mineral biomarkers. • Moderate-to-severe OSA is linked to higher very-low density lipoprotein (VLDL) and triglyceride levels. • Higher apnea-hypopnea index (AHI) is independently associated with increased VLDL and triglycerides and lower magnesium concentrations. • Sex-stratified analyses show distinct patterns: magnesium is inversely associated with AHI in men, whereas VLDL, triglycerides, and zinc are significantly associated with AHI in women.