Novel adiposity indices are better predictors of obstructive sleep apnea? Insights from NHANES

Obstructive sleep apnea (OSA) is a prevalent sleep disorder linked to obesity, increasing cardiovascular and cerebrovascular risk. While body mass index (BMI) and waist circumference (WC) are commonly used, novel anthropometric and dual-energy X-ray absorptiometry (DXA)-derived indices may provide additional insights. Data were obtained from the National Health and Nutrition Examination Survey (NHANES, 2015-2018). Weighted multivariable logistic regression, restricted cubic spline (RCS), receiver operating characteristic (ROC), and subgroup analyses were conducted to evaluate the predictive ability of classical anthropometric indices (BMI, WC, waist-to-hip ratio [WHR], waist-to-height ratio [WHTR]), novel anthropometric indices, and DXA-derived indices for OSA. A total of 2068 participants were included in the study, with a nearly balanced gender distribution. After adjusting for covariates, all adiposity indices were positively associated with OSA except for a body shape index (ABSI) and visceral-to-total abdominal adipose tissue mass ratio (VAT/TAT). Central obesity indices-WC (Odds ratio [95% confidence interval] 1.05 [1.03, 1.06]), WHTR (2.17 [1.73, 2.72]), and body roundness index (BRI, 1.39 [1.25, 1.54], all P < 0.001) had the best predictive performance (areas under the curve (AUCs): ~0.700). In addition, associations between these adiposity indices and OSA were more evident in men, drinkers, and even non-Hispanic groups. Central obesity indices, particularly WC, WHTR, and BRI, demonstrated strongest predictive capability for OSA, suggesting the pivotal role of abdominal obesity and body fat distribution in OSA risk stratification and pathophysiological assessment.

The online version contains supplementary material available at 10.1007/s41105-025-00623-7.