Key result
Higher NHHR linked to ~6% greater OSA risk per unit.
Why the study?
The non-HDL-cholesterol to HDL-cholesterol ratio is a newly proposed lipid metric, but few studies had explored its relationship with obstructive sleep apnea among middle-aged and elderly people.
Does a higher non-HDL-cholesterol to HDL-cholesterol ratio (NHHR) increase the risk of obstructive sleep apnea in adults aged ≥40 years?
Cross-Sectional (n=5,858)
Does a higher non-HDL-cholesterol to HDL-cholesterol ratio (NHHR) increase the risk of obstructive sleep apnea in adults aged ≥40 years?
Effect estimate: OR 1.06 (95% CI 1.02-1.11)
p-value: p=0.0053
NHHR shows a significant, independent, and inverted U-shaped positive association with self-reported obstructive sleep apnea risk in middle-aged and older adults, peaking at an NHHR of 5.3.
NHHR-OSA association in cross-sectional data should not change practice; leaves open prospective validation of causality and utility.
BACKGROUND: The ratio of the non-HDL-cholesterol to HDL- cholesterol (NHHR) is a newly proposed lipid metric. Currently, few studies have explored the relationship between NHHR and obstructive sleep apnea (OSA) among middle-aged and elderly people. This study aims to investigate the potential association between NHHR and OSA. METHODS: This study included participants from the NHANES 2015-2018 cycles, focusing exclusively on individuals aged 40 and above. OSA data were estimated based on questionnaire responses. NHHR was estimated as the ratio of non-HDL-C to HDL-C. Multivariable logistic regression, adjusted for covariates, subgroup analysis, and smoothing spline fittings were utilized to assess the link between NHHR and OSA. RESULTS: A total of 5,858 participants were analyzed. Multivariable logistic regression highlighted a statistically significant positive relationship between NHHR and OSA [OR 1.06 (95% CI: 1.02, 1.11), p = 0.0053]. As NHHR increased by tertiles, the risk of OSA also showed an upward trend. Subgroup and interaction analyses confirmed the overall association was robust across most confounding factors except for gender and diabetes status. Further nonlinear analyses identified a significant inverted U-shaped curve (p-nonlinearity < 0.05) with peak risk at an NHHR of 5.3. This pattern was particularly evident in males (turning point = 3.97) and diabetics (turning point = 5.61). CONCLUSION: From 2015 to 2018, among the NHANES population aged over 40, NHHR showed a significant and independent positive association with OSA risk. The consistency of this relationship across various subgroups suggests NHHR's potential as a complementary biomarker for metabolic risk assessment in OSA.
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Chen et al. (2025) conducted a cross-sectional in Obstructive sleep apnea (OSA) (n=5,858). Non-HDL-cholesterol to HDL-cholesterol ratio (NHHR) was evaluated on Obstructive sleep apnea (OSA) (OR 1.06, 95% CI 1.02-1.11, p=0.0053). Higher non-HDL-cholesterol to HDL-cholesterol ratio (NHHR) was significantly associated with an increased risk of obstructive sleep apnea, with a 6% increased risk per unit increase (OR 1.06).
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