Longitudinal analysis of anthropometric indices and the incidence of obstructive sleep apnea

This longitudinal study evaluated the predictive value of ten anthropometric indices including Waist Circumference (WC), Hip Circumference (HC), Neck Circumference (NC), Body Mass Index (BMI), Waist-to-Height Ratio (WHtR), Waist-to-Hip Ratio (WHR), A Body Shape Index (ABSI), Body Roundness Index (BRI), Weight-adjusted Waist Index (WWI), and Neck-to-Height Ratio (NHR) for incident obstructive sleep apnea (OSA), aiming to identify optimal clinical predictors.

Data were obtained from the Sleep Heart Health Study at baseline and at an average follow-up of approximately 5 years. Multivariable logistic regression (adjusted for demographics and comorbidities), restricted cubic splines, subgroup analyses, and ROC curves were used to assess associations, nonlinearity, interactions, and predictive performance, respectively.

Among 1,306 participants (876 non-OSA, 430 OSA), all indices except ABSI were significantly associated with OSA risk after adjustment, with the strongest associations observed in the highest quartiles: NC (OR = 3.11, 95% CI: 1.94-5.00, p < 0.001), followed by WHtR (OR = 2.92, 95% CI: 2.03-4.21, p < 0.001), BRI (OR = 2.92, 95% CI: 2.03-4.21, p < 0.001), WC (OR = 2.68, 95% CI: 1.84-3.83, p < 0.001), and NHR (OR = 2.67, 95% CI: 1.83-3.91, p < 0.001). BRI demonstrated a nonlinear dose-response relationship with a threshold at BRI = 5.43: below this value, OSA risk increased significantly (OR = 1.48 per unit); above it, no further risk increase was observed. WHtR showed a linear association with OSA. In ROC analysis, both WHtR and BRI had the highest discriminative ability (AUC = 0.624), while NHR also showed comparable predictive performance (AUC = 0.620).

WHtR and BRI are key anthropometric predictors for OSA, with BRI displaying a threshold effect. NHR also shows potential as a supplementary screening marker.