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February 28, 2026Journal of Clinical Medicine0 citationsOpen Access

Serum Perilipin-2 as a Novel Biomarker for Obstructive Sleep Apnea: Association with Hypoxic Burden and Disease Severity

GSGülseren SağcanHUHafize Uzun

Key Result

Serum PLIN-2 levels increased with OSA severity and showed good discrimination for OSA presence with AUC 0.849, but lost independent association with OSA after adjusting for insulin resistance.

Key Points

  • This research investigates the link between serum Perilipin-2 levels and the severity of obstructive sleep apnea (OSA).
  • Included 231 participants: 70 healthy controls and 161 patients with OSA.
  • Classified patients by apnea–hypopnea index (AHI): mild, moderate, and severe OSA.
  • Conducted overnight polysomnography (PSG) to assess OSA severity.
  • Serum PLIN-2 levels were significantly higher in OSA patients compared to controls.
  • PLIN-2 levels increased progressively with OSA severity: mild, moderate, and severe.
  • Positive correlation observed between PLIN-2 levels and AHI as well as oxygen desaturation index.
  • ROC analysis indicated strong discriminative ability of PLIN-2 for OSA and for differentiating severity levels.

Study Design

Type

Cross-Sectional (n=231)

Multicenter

No

Structured PICO

Do serum PLIN-2 levels correlate with the presence and severity of obstructive sleep apnea?

P
Population
231 participants comprising 70 healthy controls and 161 patients with obstructive sleep apnea (OSA) classified by apnea-hypopnea index as mild (n=60), moderate (n=52), or severe (n=49).
I
Intervention
Measurement of serum Perilipin-2 (PLIN-2) levels
C
Comparator
Healthy controls (n=70) and comparison across different OSA severity groups
O
Outcome
Association between serum PLIN-2 levels and OSA presence, and relationship with disease severity (apnea-hypopnea index and oxygen desaturation index)surrogate

Serum PLIN-2 is a novel biomarker that correlates with the presence and severity of obstructive sleep apnea, potentially reflecting associated metabolic and lipid-related disturbances.

Main Result

Effect estimate: OR 2.62 for BMI; PLIN-2 independently associated with OSA presence before insulin resistance adjustment (p=0.002); lost significance after adjustment (OR 0.89, 95% CI 0.28–2.83, p=0.842) (95% CI 95% CI 0.28–2.83 for PLIN-2 in extended model)

p-value: p=0.002 (unadjusted), 0.842 (adjusted)

Limitations

  • Cross-sectional design limits causal inference
  • Single-center study limits generalizability
  • Control group metabolically healthier than general population
  • Possible residual confounding and unmeasured variables
  • PLIN-2 performance limited by modest sensitivity at optimal cut-off

Abstract

Background: Obstructive sleep apnea (OSA) syndrome is a common sleep-related breathing disorder characterized by recurrent upper airway collapse during sleep and is closely associated with metabolic dysregulation, including insulin resistance, adipose tissue dysfunction, and impaired lipid metabolism. Perilipin-2 (PLIN-2), a lipid droplet-associated protein involved in triglyceride storage and regulation of lipolysis, may reflect alterations in lipid homeostasis associated with OSA. Objective: This study aimed to evaluate the association between serum PLIN-2 levels and OSA and to assess the relationship between PLIN-2 concentrations and disease severity. Methods: A total of 231 participants were included in this study, comprising 70 healthy controls and 161 patients with OSA. Patients were classified according to apnea–hypopnea index (AHI) as having mild (n = 60), moderate (n = 52), or severe OSA (n = 49). All participants underwent overnight polysomnography (PSG). Results: Serum PLIN-2 levels were significantly higher in patients with OSA and increased progressively with disease severity. PLIN-2 levels were positively correlated with polysomnographic indices of OSA severity, including AHI and oxygen desaturation index. ROC analysis demonstrated good discriminative performance of PLIN-2 for OSA presence and for distinguishing mild from severe OSA. Conclusions: This study is the first to demonstrate an association between serum PLIN-2 levels and OSA. Our findings suggest that PLIN-2 may serve as a novel biomarker reflecting metabolic and lipid-related disturbances in OSA and may provide new insights into the pathophysiological link between intermittent hypoxia and altered lipid metabolism.

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Cite This Study

Sağcan et al. (2026) conducted a cross-sectional in Adults aged ≥18 years with obstructive sleep apnea diagnosed by polysomnography, classified as mild, moderate, or severe, and healthy controls without sleep-disordered breathing or metabolic disease (n=231). Serum Perilipin-2 measurement vs. Healthy controls without OSA was evaluated on Presence of obstructive sleep apnea diagnosed by polysomnography (AHI ≥5) (OR 2.62 for BMI; PLIN-2 independently associated with OSA presence before insulin resistance adjustment (p=0.002); lost significance after adjustment (OR 0.89, 95% CI 0.28–2.83, p=0.842), 95% CI 95% CI 0.28–2.83 for PLIN-2 in extended model, p=0.002 (unadjusted), 0.842 (adjusted)). Serum PLIN-2 levels increased with OSA severity and showed good discrimination for OSA presence with AUC 0.849, but lost independent association with OSA after adjusting for insulin resistance.

synapsesocial.com/papers/69a286b80a974eb0d3c01d78https://doi.org/10.3390/jcm15051776
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