Increased Association Between Obstructive Sleep Apnea with Hypertension, Diabetes, Dyslipidemia, Chronic Renal Disease, and increasing weight with lower prevalence in cachexia

ABSTRACT Obstructive sleep apnea (OSA), defined as recurrent episodes of upper airway obstruction during sleep, has been associated with multiple cardiovascular and metabolic comorbidities. While prior studies have demonstrated a link between OSA and adverse cardiovascular outcomes, the strength and nature of this relationship remain controversial. We aimed to investigate the association between OSA and major cardiovascular and metabolic conditions, including myocardial infarction (MI), hypertension (HTN), diabetes mellitus (DM), dyslipidemia, obesity, and chronic kidney disease (CKD), as well as the impact of OSA on in-hospital mortality using a large national dataset. Materials and Methods We conducted a retrospective analysis using the National Inpatient Sample (NIS) database from 2016 to 2020, including over 148 million hospital discharge records. Diagnoses were identified using ICD-10 codes. Multivariate logistic regression was performed to assess adjusted odds ratios (aORs) for each outcome, accounting for potential confounders. A separate mortality analysis was conducted to evaluate in-hospital mortality among patients with and without OSA. After adjusting for confounding factors, OSA was not independently associated with an increased risk of MI (STEMI or NSTEMI). However, OSA was significantly associated with increased odds of HTN (aOR: 1.79), DM (aOR: 1.40), dyslipidemia, obesity (aOR: 3.36), morbid obesity (aOR: 8.25), and CKD, all with p < 0.001. In-hospital mortality analysis revealed worse outcomes in patients with cardiovascular comorbidities such as HTN, DM, dyslipidemia, and obesity. OSA may not be directly associated with MI, but it is strongly linked to its major risk factors. It may exert a cardioprotective effect in the context of STEMI, potentially due to ischemic preconditioning or heightened clinical surveillance. Conversely, OSA appears to worsen in-hospital mortality in patients with chronic cardiometabolic conditions, underscoring the need for early diagnosis and integrated management strategies tailored to comorbid risk profiles.