Anthropometric indicators and risk of obstructive sleep apnea : Role of HDL-C as a potential mediator
- 1Department of Geriatric Respiratory Medicine, Hebei General Hospital, Shijiazhuang, People’s Republic of China
- 2The Second People’s Hospital of Xinxiang, Xinxiang, People’s Republic of China
- 3Clinical Medical College, Jining Medical University, Jining, People’s Republic of China.
Abstract
This cross-sectional study analyzed data from 9068 U.S. adults (weighted n = 170.2 million) in the 2015–2020 NHANES. It aimed to elucidate the nonlinear relationships between six anthropometric indices – Relative Fat Mass Index (RFM), Body Roundness Index (BRI), Weight-adjusted Waist Index (WWI), Body Mass Index (BMI), and waist circumference – and obstructive sleep apnea (OSA) risk. Furthermore, we pioneered an exploration of the potential mediating role of high-density lipoprotein cholesterol (HDL-C). Multivariable logistic regression, adjusted for sociodemographic, behavioral, and clinical confounders, revealed significant positive trends between all indices and OSA risk (P for trend < .05). Threshold effect models and smooth curve fitting identified distinct association patterns. RFM exhibited a linear dose-response relationship with OSA (P < .05), whereas BRI, WWI, BMI, and waist circumference demonstrated nonlinear positive correlations with identifiable inflection points (P < .05). Bootstrap mediation analysis (1000 replications) yielded results consistent with a significant mediating role for HDL-C, which explained 5.6 to 21.9% of the observed associations. This effect was most pronounced for WWI (13.2%). Stratified analyses indicated enhanced associations in participants aged < 60 years (interaction P < .05). These findings establish RFM as a linear predictor of OSA, contrasting with the nonlinear dynamics of other adiposity indices. The partial mediation by HDL-C underscores dysregulated lipid metabolism as a key pathological mechanism linking obesity to OSA, supporting the integration of anthropometric screening with lipid profiling to optimize clinical risk stratification and early intervention strategies.
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BibTeX
@article{jiang2026anthropometric,
title = {{Anthropometric indicators and risk of obstructive sleep apnea : Role of HDL-C as a potential mediator}},
author = {Sheng Yue Jiang and Xue Lian Du and Zi Qian Luo and Ping Ping Xu and Ya Qi Liang and Pang Pang Zhang and Fen Ping and Ping Li},
journal = {Medicine},
year = {2026},
month = oct,
doi = {10.1097/md.0000000000051275},
url = {https://europepmc.org/article/PMC/PMC13727269},
note = {CC BY},
}
RIS
TY - JOUR
TI - Anthropometric indicators and risk of obstructive sleep apnea : Role of HDL-C as a potential mediator
AU - Sheng Yue Jiang
AU - Xue Lian Du
AU - Zi Qian Luo
AU - Ping Ping Xu
AU - Ya Qi Liang
AU - Pang Pang Zhang
AU - Fen Ping
AU - Ping Li
PY - 2026
DA - 2026/10/30
JO - Medicine
DO - 10.1097/md.0000000000051275
UR - https://europepmc.org/article/PMC/PMC13727269
AB - This cross-sectional study analyzed data from 9068 U.S. adults (weighted n = 170.2 million) in the 2015–2020 NHANES. It aimed to elucidate the nonlinear relationships between six anthropometric indices – Relative Fat Mass Index (RFM), Body Roundness Index (BRI), Weight-adjusted Waist Index (WWI), Body Mass Index (BMI), and waist circumference – and obstructive sleep apnea (OSA) risk. Furthermore, we pioneered an exploration of the potential mediating role of high-density lipoprotein cholesterol (HDL-C). Multivariable logistic regression, adjusted for sociodemographic, behavioral, and clinical confounders, revealed significant positive trends between all indices and OSA risk (P for trend < .05). Threshold effect models and smooth curve fitting identified distinct association patterns. RFM exhibited a linear dose-response relationship with OSA (P < .05), whereas BRI, WWI, BMI, and waist circumference demonstrated nonlinear positive correlations with identifiable inflection points (P < .05). Bootstrap mediation analysis (1000 replications) yielded results consistent with a significant mediating role for HDL-C, which explained 5.6 to 21.9% of the observed associations. This effect was most pronounced for WWI (13.2%). Stratified analyses indicated enhanced associations in participants aged < 60 years (interaction P < .05). These findings establish RFM as a linear predictor of OSA, contrasting with the nonlinear dynamics of other adiposity indices. The partial mediation by HDL-C underscores dysregulated lipid metabolism as a key pathological mechanism linking obesity to OSA, supporting the integration of anthropometric screening with lipid profiling to optimize clinical risk stratification and early intervention strategies.
SN - 0304-5412
SN - 1536-5964
SN - 0025-7974
ER -