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cardiometabolic disease, multivariable apnea prediction, metabolic syndrome, sleep apnea



  1. Kariuki, Jacob K. PhD, AGNP-BC
  2. Yang, Kyeongra PhD, MPH, RN
  3. Scott, Paul W. PhD
  4. Chasens, Eileen R. PhD, RN, FAAN
  5. Godzik, Cassandra PhD, APRN
  6. Luyster, Faith S. PhD
  7. Imes, Christopher C. PhD, RN


Background: Metabolic syndrome (MetS) and obstructive sleep apnea (OSA) are associated with increased risk of cardiometabolic disease. The co-occurrence of OSA with MetS is common, but there are limited data on how OSA risk exacerbates the metabolic impairments present in MetS. The purpose of this analysis was to examine in a representative sample of participants in the National Health and Nutrition Examination Survey 2015-2018 cohorts (1) the association of modifiable cardiometabolic risk factors with OSA risk and MetS severity and (2) the influence of OSA risk and lifestyle behaviors on MetS severity.


Methods: Metabolic syndrome severity was assessed using MetS Z score, whereas the risk of OSA was measured via multivariable apnea prediction index. Data analyses were conducted using the sample weights provided by the National Health and Nutrition Examination Survey.


Results: The sample (N = 11 288) included adults (>20 years old) who were overweight (mean body mass index, 29.6 +/- 0.2 kg/m2), representative by race (36.9% non-White) and gender (51.9% female). Overall, 19.3% of the sample had elevated MetS severity (MetS Z score >= 1), and 38.4% were at a high risk of OSA (multivariable apnea prediction score of >=0.50). High OSA risk was associated with having elevated MetS severity (odds ratio [OR], 4.94; 95% confidence interval [CI], 3.68-6.65). Obstructive sleep apnea risk predicted increased MetS severity (adjusted: B = 0.06, SE = 0.02, P = .013). Physical activity provided the highest protection from increased MetS severity (OR, 0.52; 95% CI, 0.39-0.70) and OSA risk (OR, 0.59; 95% CI, 0.53-0.66).


Conclusion: Our findings suggest that increased OSA risk exacerbates MetS severity and that greater physical activity may mitigate the risk.