# Association of non-high-density lipoprotein cholesterol to high-density lipoprotein cholesterol ratio and atherogenic index of plasma with obstructive sleep apnea

## TL;DR

This study found that two cholesterol-related measures are linked to sleep apnea and could help diagnose it.

## Contribution

The study identifies NHHR and AIP as independent risk factors and potential diagnostic tools for OSA.

## Key findings

- NHHR and AIP were independent risk factors for obstructive sleep apnea (OSA).
- The combined model of NHHR and AIP had a higher diagnostic accuracy (AUC 0.763) than either alone.

## Abstract

Obstructive sleep apnea (OSA) is a prevalent sleep disorder associated with metabolic, cardiovascular disorders. The non-high-density lipoprotein cholesterol to high-density lipoprotein cholesterol ratio (NHHR) and atherogenic index of plasma (AIP) are thought to be better ways to detect cardiovascular diseases than single lipid parameters. The relationship between NHHR or AIP and OSA remains ambiguous.

454 consecutive patients with suspected OSA were enrolled between June 2023 and February 2025. The OSA was defined as the occurrence of more than 5 apnea-hypopnea index (AHI) events/h. Spearman’s rank correlation analysis among the NHHR, AIP, AHI, and lowest SpO2. Binary logistic regression analysis was conducted to investigate the association between the NHHR and AIP with OSA. To evaluate the diagnostic performance of the NHHR and AIP for OSA, we conducted receiver operating characteristic (ROC) curve analysis.

Among the 454 recruited patients, 318 (70.04%) were diagnosed with OSA. A binary logistic regression model showed that the NHHR (odds ratio [OR], 1.559; 95% CI 1.268–1.915, p<0.001) and AIP (OR, 1.349; 95% CI 1.146–1.843, p < 0.001) were independent factors for OSA. The area under the curve (AUC) values for the identifying OSA were 0.730 for the NHHR, 0.658 for the AIP and 0.763 for the combined model, respectively.

Our study indicates the NHHR and AIP were independent risk factors for OSA and can be used as potential tools for OSA.