Association between obstructive sleep apnea and lipid metabolism during REM and NREM sleep

Obstructive sleep apnea (OSA) is thought to be associated with dyslipidemia. However, differences concerning dyslipidemia during rapid eye movement (REM) and non-REM (NREM) sleep have yet to be determined. This study was designed to explore the association between lipid profiles and OSA during REM or NREM sleep.

This is a clinical cohort. A total of 2,619 participants with at least 30 minutes of REM sleep were included. Sleep variables and fasting lipid profiles [total cholesterol (TC), triglycerides (TG), low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), apolipoprotein (apo)A-I, apoB, apoE, and lipoprotein(a) (Lp(a))] were obtained from each participant. Apnea-hypopnea indices in REM and NREM sleep (AHI_REM and AHI_NREM, respectively) were recorded. Linear regression analysis was used to assess the associations of AHI_REM and AHI_NREM with lipid profiles.

When stratified by the AHI_REM severity of OSA, all demographics, clinical variables, and sleep parameters differed between the groups except for apoA-I. In fully-adjusted multivariate linear regression models, AHI_REM was independently associated with increasing levels of TG, HDL-C, and apoE (P = .04, P = .01 and P = .01, respectively). AHI_NREM was independently associated with increasing levels of TC, TG, LDL, and apoB, and lower level of HDL-C (all P < .05). In sensitivity analyses by only exploring associations in patients who had an AHI_NREM or AHI_REM < 5 events/h in separate regression models, AHI_REM was not associated with all-lipid profile in almost all adjusted models (all P > .05), whereas AHI_NREM was associated with elevated TC, LDL-C, and apoB (P = .03, P = .01 and P = .01, respectively).

AHI_NREM was independently associated with the greatest alterations in serum lipids, including TC, LDL-C, and apoB.