The association of the non-HDL-cholesterol to HDL-cholesterol ratio (NHHR) with obstructive sleep apnea among adults aged ≥ 40 years: results from NHANES 2015–2018
Abstract Background The ratio of the non-HDL-cholesterol to HDL- cholesterol (NHHR) is a newly proposed lipid metric. Currently, few studies have explored the relationship between NHHR and obstructive sleep apnea (OSA) among middle-aged and elderly people. This study aims to investigate the potentia...
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2025-05-01
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| Online Access: | https://doi.org/10.1186/s12889-025-23274-2 |
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| author | Lvao Chen Jiuming Chen Shikai Chen Yingchao Cui |
| author_facet | Lvao Chen Jiuming Chen Shikai Chen Yingchao Cui |
| author_sort | Lvao Chen |
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| description | Abstract Background The ratio of the non-HDL-cholesterol to HDL- cholesterol (NHHR) is a newly proposed lipid metric. Currently, few studies have explored the relationship between NHHR and obstructive sleep apnea (OSA) among middle-aged and elderly people. This study aims to investigate the potential association between NHHR and OSA. Methods This study included participants from the NHANES 2015–2018 cycles, focusing exclusively on individuals aged 40 and above. OSA data were estimated based on questionnaire responses. NHHR was estimated as the ratio of non-HDL-C to HDL-C. Multivariable logistic regression, adjusted for covariates, subgroup analysis, and smoothing spline fittings were utilized to assess the link between NHHR and OSA. Results A total of 5,858 participants were analyzed. Multivariable logistic regression highlighted a statistically significant positive relationship between NHHR and OSA [OR 1.06 (95% CI: 1.02, 1.11), p = 0.0053]. As NHHR increased by tertiles, the risk of OSA also showed an upward trend. Subgroup and interaction analyses confirmed the overall association was robust across most confounding factors except for gender and diabetes status. Further nonlinear analyses identified a significant inverted U-shaped curve (p-nonlinearity < 0.05) with peak risk at an NHHR of 5.3. This pattern was particularly evident in males (turning point = 3.97) and diabetics (turning point = 5.61). Conclusion From 2015 to 2018, among the NHANES population aged over 40, NHHR showed a significant and independent positive association with OSA risk. The consistency of this relationship across various subgroups suggests NHHR’s potential as a complementary biomarker for metabolic risk assessment in OSA. |
| format | Article |
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| language | English |
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| series | BMC Public Health |
| spelling | doaj-art-b86b74fd0138478e873bc5fbe157c7bc2025-08-20T02:00:00ZengBMCBMC Public Health1471-24582025-05-0125111010.1186/s12889-025-23274-2The association of the non-HDL-cholesterol to HDL-cholesterol ratio (NHHR) with obstructive sleep apnea among adults aged ≥ 40 years: results from NHANES 2015–2018Lvao Chen0Jiuming Chen1Shikai Chen2Yingchao Cui3Department of Laboratory Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine. NoDepartment of Laboratory Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine. NoDepartment of Laboratory Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine. NoDepartment of Laboratory Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine. NoAbstract Background The ratio of the non-HDL-cholesterol to HDL- cholesterol (NHHR) is a newly proposed lipid metric. Currently, few studies have explored the relationship between NHHR and obstructive sleep apnea (OSA) among middle-aged and elderly people. This study aims to investigate the potential association between NHHR and OSA. Methods This study included participants from the NHANES 2015–2018 cycles, focusing exclusively on individuals aged 40 and above. OSA data were estimated based on questionnaire responses. NHHR was estimated as the ratio of non-HDL-C to HDL-C. Multivariable logistic regression, adjusted for covariates, subgroup analysis, and smoothing spline fittings were utilized to assess the link between NHHR and OSA. Results A total of 5,858 participants were analyzed. Multivariable logistic regression highlighted a statistically significant positive relationship between NHHR and OSA [OR 1.06 (95% CI: 1.02, 1.11), p = 0.0053]. As NHHR increased by tertiles, the risk of OSA also showed an upward trend. Subgroup and interaction analyses confirmed the overall association was robust across most confounding factors except for gender and diabetes status. Further nonlinear analyses identified a significant inverted U-shaped curve (p-nonlinearity < 0.05) with peak risk at an NHHR of 5.3. This pattern was particularly evident in males (turning point = 3.97) and diabetics (turning point = 5.61). Conclusion From 2015 to 2018, among the NHANES population aged over 40, NHHR showed a significant and independent positive association with OSA risk. The consistency of this relationship across various subgroups suggests NHHR’s potential as a complementary biomarker for metabolic risk assessment in OSA.https://doi.org/10.1186/s12889-025-23274-2Non-high density lipoprotein cholesterolHigh density lipoprotein cholesterolObstructive sleep apneaMiddle-agedElderly |
| spellingShingle | Lvao Chen Jiuming Chen Shikai Chen Yingchao Cui The association of the non-HDL-cholesterol to HDL-cholesterol ratio (NHHR) with obstructive sleep apnea among adults aged ≥ 40 years: results from NHANES 2015–2018 BMC Public Health Non-high density lipoprotein cholesterol High density lipoprotein cholesterol Obstructive sleep apnea Middle-aged Elderly |
| title | The association of the non-HDL-cholesterol to HDL-cholesterol ratio (NHHR) with obstructive sleep apnea among adults aged ≥ 40 years: results from NHANES 2015–2018 |
| title_full | The association of the non-HDL-cholesterol to HDL-cholesterol ratio (NHHR) with obstructive sleep apnea among adults aged ≥ 40 years: results from NHANES 2015–2018 |
| title_fullStr | The association of the non-HDL-cholesterol to HDL-cholesterol ratio (NHHR) with obstructive sleep apnea among adults aged ≥ 40 years: results from NHANES 2015–2018 |
| title_full_unstemmed | The association of the non-HDL-cholesterol to HDL-cholesterol ratio (NHHR) with obstructive sleep apnea among adults aged ≥ 40 years: results from NHANES 2015–2018 |
| title_short | The association of the non-HDL-cholesterol to HDL-cholesterol ratio (NHHR) with obstructive sleep apnea among adults aged ≥ 40 years: results from NHANES 2015–2018 |
| title_sort | association of the non hdl cholesterol to hdl cholesterol ratio nhhr with obstructive sleep apnea among adults aged ≥ 40 years results from nhanes 2015 2018 |
| topic | Non-high density lipoprotein cholesterol High density lipoprotein cholesterol Obstructive sleep apnea Middle-aged Elderly |
| url | https://doi.org/10.1186/s12889-025-23274-2 |
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