Key result
Higher hypoxic burden is linked to ~2.5-fold higher hypercholesterolemia risk, partly mediated by autonomic imbalance.
Why the study?
Obstructive sleep apnea is associated with cardiac autonomic dysfunction and impaired lipid homeostasis, but whether cardiac autonomic imbalance mediates the association between hypoxic burden and dyslipidemia was unknown.
Is hypoxic burden independently associated with dyslipidemia in patients with suspected obstructive sleep apnea, and is this association mediated by cardiac autonomic imbalance?
Cross-Sectional (n=2,580)
No
Is hypoxic burden independently associated with dyslipidemia in patients with suspected obstructive sleep apnea, and is this association mediated by cardiac autonomic imbalance?
Odds Ratio: 2.518 (95% CI 1.701–3.727)
Absolute Event Rate: 37.71% vs 18.16%
p-value: p=<0.001
Hypoxic burden in obstructive sleep apnea is independently associated with dyslipidemia, and this relationship is partially mediated by cardiac autonomic dysfunction.
May extend OSA-dyslipidemia links via autonomic pathways; leaves open causal inference and practice change.
BACKGROUND: Obstructive sleep apnea (OSA) is associated with cardiac autonomic dysfunction and impaired lipid homeostasis. We investigated whether cardiac autonomic imbalance mediates the association between hypoxic burden (HB) and dyslipidemia. METHODS: Between January 2022 and March 2026, we consecutively enrolled 2,580 patients with suspected OSA for cross-sectional evaluation. All underwent overnight polysomnography and fasting lipid profiling. HB served as the exposure, heart rate variability (HRV) indices (pNN50 and LF/HF ratio) as mediators, and lipid parameters (LDL-C, total cholesterol, triglycerides) as outcomes. Multivariable logistic regression estimated odds ratios (ORs) for dyslipidemia across HB quartiles, and mediation analysis quantified indirect effects transmitted through HRV. RESULTS: ) individuals but were attenuated in older (>60 years) and obese individuals. Mediation analysis indicated that the HRV indices statistically accounted for part of these associations, consistent with a potential mediating role. The indirect effects (bootstrap 95% CI) of pNN50 on LDL-C, total cholesterol, and triglycerides were 0.004, 0.010, and 0.007, accounting for approximately 4.3%, 8.4%, and 3.8% of the total effect; the corresponding indirect effects of the LF/HF ratio were 0.004, 0.006, and 0.007, accounting for approximately 4.3%, 5.1%, and 3.8% of the total effect. CONCLUSIONS: HB is independently associated with dyslipidemia, an association that is partially mediated by cardiac autonomic imbalance, particularly in younger, female, and non-obese populations.
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Li et al. (2026) conducted a cross-sectional in Suspected obstructive sleep apnea (n=2,580). Hypoxic burden vs. Lowest quartile of hypoxic burden was evaluated on Hypercholesterolemia (OR 2.518, 95% CI 1.701-3.727, p=<0.001). Higher hypoxic burden was independently associated with an increased risk of hypercholesterolemia (OR 2.518 for the highest vs lowest quartile), an association partially mediated by cardiac autonomic imbalance.
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