title: Distinct severity stages of obstructive sleep apnoea are correlated with unique dyslipidaemia: large-scale observational study.
abstract: BACKGROUND
  Dyslipidaemia is an intermediary exacerbation factor for various diseases but the impact of obstructive sleep apnoea (OSA) on dyslipidaemia remains unclear.
  
  
  METHODS
  A total of 3582 subjects with suspected OSA consecutively admitted to our hospital sleep centre were screened and 2983 (2422 with OSA) were included in the Shanghai Sleep Health Study. OSA severity was quantified using the apnoea-hypopnea index (AHI), the oxygen desaturation index and the arousal index. Biochemical indicators and anthropometric data were also collected. The relationship between OSA severity and the risk of dyslipidaemia was evaluated via ordinal logistic regression, restricted cubic spline (RCS) analysis and multivariate linear regressions.
  
  
  RESULTS
  The RCS mapped a nonlinear dose-effect relationship between the risk of dyslipidaemia and OSA severity, and yielded knots of the AHI (9.4, 28.2, 54.4 and 80.2). After integrating the clinical definition and RCS-selected knots, all subjects were regrouped into four AHI severity stages. Following segmented multivariate linear modelling of each stage, distinguishable sets of OSA risk factors were quantified: low-density lipoprotein cholesterol (LDL-C), apolipoprotein E and high-density lipoprotein cholesterol (HDL-C); body mass index and/or waist to hip ratio; and HDL-C, LDL-C and triglycerides were specifically associated with stage I, stages II and III, and stages II-IV with different OSA indices.
  
  
  CONCLUSIONS
  Our study revealed the multistage and non-monotonic relationships between OSA and dyslipidaemia and quantified the relationships between OSA severity indexes and distinct risk factors for specific OSA severity stages. Our study suggests that a new interpretive and predictive strategy for dynamic assessment of the risk progression over the clinical course of OSA should be adopted.
authors.affiliation: Department of Otolaryngology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China Department of Otolaryngology, Therapy Center for Obstructive Sleep Apnea, Otolaryngology Institute of Shanghai Jiao Tong University, Shanghai China.
authors.forename: Jian
authors.initials: J
authors.lastname: Guan
authors.affiliation: Department of Otolaryngology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China Department of Otolaryngology, Therapy Center for Obstructive Sleep Apnea, Otolaryngology Institute of Shanghai Jiao Tong University, Shanghai China.
authors.forename: Hongliang
authors.initials: H
authors.lastname: Yi
authors.affiliation: Department of Otolaryngology, Therapy Center for Obstructive Sleep Apnea, Otolaryngology Institute of Shanghai Jiao Tong University, Shanghai China.
authors.forename: Jianyin
authors.initials: J
authors.lastname: Zou
authors.affiliation: Department of Otolaryngology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China.
authors.forename: Lili
authors.initials: L
authors.lastname: Meng
authors.affiliation: Department of Otolaryngology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China.
authors.forename: Xulan
authors.initials: X
authors.lastname: Tang
authors.affiliation: Department of Otolaryngology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China.
authors.forename: Huaming
authors.initials: H
authors.lastname: Zhu
authors.affiliation: Department of Otolaryngology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China Department of Otolaryngology, Therapy Center for Obstructive Sleep Apnea, Otolaryngology Institute of Shanghai Jiao Tong University, Shanghai China.
authors.forename: Dongzhen
authors.initials: D
authors.lastname: Yu
authors.affiliation: Department of Otolaryngology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China.
authors.forename: Huiqun
authors.initials: H
authors.lastname: Zhou
authors.affiliation: Department of Otolaryngology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China Department of Otolaryngology, Therapy Center for Obstructive Sleep Apnea, Otolaryngology Institute of Shanghai Jiao Tong University, Shanghai China.
authors.forename: Kaiming
authors.initials: K
authors.lastname: Su
authors.affiliation: Institute of Neuroscience, Shanghai Institutes for Biological Sciences, Chinese Academy of Sciences, Shanghai, China.
authors.forename: Mingpo
authors.initials: M
authors.lastname: Yang
authors.affiliation: Department of Gastroenterology and Hepatology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.
authors.forename: Haoyan
authors.initials: H
authors.lastname: Chen
authors.affiliation: Key Laboratory for the Genetics of Developmental and Neuropsychiatric Disorders, Bio-X Institutes, Ministry of Education, Shanghai Jiao Tong University, Shanghai, China.
authors.forename: Yongyong
authors.initials: Y
authors.lastname: Shi
authors.affiliation: The Center for Disease Control and Prevention of China, Beijing, China.
authors.forename: Yue
authors.initials: Y
authors.lastname: Wang
authors.affiliation: School of Human Communication Disorders, Dalhousie University, Halifax, Canada.
authors.forename: Jian
authors.initials: J
authors.lastname: Wang
authors.affiliation: Department of Otolaryngology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China Department of Otolaryngology, Therapy Center for Obstructive Sleep Apnea, Otolaryngology Institute of Shanghai Jiao Tong University, Shanghai China.
authors.forename: Shankai
authors.initials: S
authors.lastname: Yin
mesh_terms: D000328:Adult; D001053:Apolipoproteins / Q000097:blood*; D015415:Biomarkers / Q000097:blood; D015992:Body Mass Index; D002318:Cardiovascular Diseases / Q000150:complications; D008076:Cholesterol, HDL / Q000097:blood*; D008078:Cholesterol, LDL / Q000097:blood*; D050171:Dyslipidemias / Q000097:blood* / Q000150:complications / Q000175:diagnosis; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000150:complications; D017286:Polysomnography; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D020181:Sleep Apnea, Obstructive / Q000097:blood* / Q000150:complications / Q000175:diagnosis / Q000209:etiology; D014280:Triglycerides / Q000097:blood*
chemical_list: D001053:Apolipoproteins; D015415:Biomarkers; D008076:Cholesterol, HDL; D008078:Cholesterol, LDL; D014280:Triglycerides
keywords: Sleep apnoea