Previous studies have reported the effects of
obstructive sleep apnea (OSA) and cardiometabolic disorders on
cardiovascular disease (CVD), but associations between cardiometabolic
biomarkers and two cardinal features of OSA (chronic intermittent
hypoxia and
sleep fragmentation) and their interactions on CVD in OSA populations remain unclear. A total of 1727 subjects were included in this observational study. Data on overnight polysomnography parameters, biochemical
biomarkers, and anthropometric measurements were collected.
Metabolic syndrome (MS), including blood pressure, waist circumference (WC), fasting
glucose,
triglycerides (TG), and
high-density lipoprotein cholesterol (HDL-C), was diagnosed based on modified criteria of the Adult Treatment Panel III. WC, mean arterial pressure, TG and
low-density lipoprotein cholesterol (
LDL-C) were independently associated with
apnea-hypopnea index (AHI) after adjustment for confounding factors (β = 0.578, P = 0.000; β = 0.157, P = 0.001; β = 1.003, P = 0.019; and β = 4.067, P = 0.0005, respectively). Furthermore, the interaction analysis revealed joint effects between
hypertension,
obesity,
hyperglycemia, and
LDL-C
dyslipidemia and AHI on CVD. The relative excess risks of CVD due to the interactions with OSA were 2.06, 1.02, 0.48, and 1.42, respectively (all P < 0.05). In contrast, we found no independent effect of the microarousal index (MAI) on CVD. However,
LDL-C level and some MS components (WC, TG) were associated with MAI. Our findings indicate that
hypoxemia and cardiometabolic disorders in OSA may potentiate their unfavorable effects on CVD.
Sleep fragmentation may indirectly predispose patients with OSA to an increased risk of CVD. Thus, cardiometabolic disorders and OSA synergistically influence cardiometabolic risk patterns.