Metabolic Subphenotypes of Obstructive Sleep Apnea: NHANES 2017-2020 (pre-pandemic)

Background OSA and MetS have a bidirectional relationship but increasing evidence suggests metabolic heterogeneity in OSA, systematic phenotyping of metabolic drivers in OSA are lack.

To identify metabolic subphenotypes of OSA and elucidate potential pathophysiological mechanisms using population-level data.

To analyze the data related to OSA and MetS from 2,260 participants in the NHANES database (2017–2020, pre-pandemic) using PCA and machine learning.

48.74% (1689/3465) participants were identified as OSA. PCA revaled that the first 6 PCs explained 85% of the variance in both overall and OSA participants, encompassing indicators of obesity, hypertension, dyslipidemia, and IR. Indicators with |loading value|≥0.6 in each PCs included obesity (Height, Weight, BMI, Waist, Hipline, W/H), blood pressure, blood lipids (CHOL, TG, LDL, HDL), and IR (GHB, GLU, VAI, LAP, TyG). Cluster analysis divided the overall participant into 6 clusters. Compared with Cluster 1 (32.92%), Cluster 2 (57.04%), Cluster 3 (57.21%), Cluster 4 (61.94%), Cluster 5 (47.69%) and Cluster 6 (50.80%) represented groups with higher prevalence of OSA, characterized by IR, isolated obesity, central obesity combined with hypertension, dyslipidemia and hypertension respectively. OSA participants were divided into 8 clusters. Cluster A, Cluster C, Cluster E, Cluster F were characterized by hypertension, dyslipidemia, isolated obesity and obesity combined with hypertension respectively. Cluster B had metabolic indicators better than average level. Clusters G and H were mainly characterized by IR.

Metabolic heterogeneity in the population is associated with the incidence of OSA. Metabolic characteristics of OSA populations may guide the treatment of OSA and its comorbidities. Competing Interest Statement The authors have declared no competing interest. Funding Statement no Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: Yantai Yuhuangding Hospital I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes Footnotes Conflict of interest: The authors declare that they have no conflicts of interest. Data availability The data underlying this article will be shared on reasonable request to the corresponding author.