The mediating role of cardiac autonomic imbalance in the association between hypoxic burden and dyslipidemia in obstructive sleep apnea.

Authors

Chenyang Li, Bingchan Li, Enhui Zhou, Jian Guan, Huajun Xu, Yupu Liu, Jianyin Zou, Hongliang Yi, Shankai Yin

Published in

Annals of medicine. Volume 58. Issue 1. Pages 2721712. Epub Aug 27, 2026.

Abstract

Obstructive sleep apnea (OSA) is associated with cardiac autonomic dysfunction and impaired lipid homeostasis. We investigated whether cardiac autonomic imbalance mediates the association between hypoxic burden (HB) and dyslipidemia.
Between January 2022 and March 2026, we consecutively enrolled 2,580 patients with suspected OSA for cross-sectional evaluation. All underwent overnight polysomnography and fasting lipid profiling. HB served as the exposure, heart rate variability (HRV) indices (pNN50 and LF/HF ratio) as mediators, and lipid parameters (LDL-C, total cholesterol, triglycerides) as outcomes. Multivariable logistic regression estimated odds ratios (ORs) for dyslipidemia across HB quartiles, and mediation analysis quantified indirect effects transmitted through HRV.
Higher HB quartiles were progressively associated with increased risk of elevated LDL-C (OR, 2.372; p < 0.001), hypercholesterolemia (OR, 2.518; p < 0.001), and hypertriglyceridemia (OR, 1.933; p = 0.021). These associations were robust among younger (<45 years), female, and normal-weight (BMI < 24 kg/m²) individuals but were attenuated in older (>60 years) and obese individuals. Mediation analysis indicated that the HRV indices statistically accounted for part of these associations, consistent with a potential mediating role. The indirect effects (bootstrap 95% CI) of pNN50 on LDL-C, total cholesterol, and triglycerides were 0.004, 0.010, and 0.007, accounting for approximately 4.3%, 8.4%, and 3.8% of the total effect; the corresponding indirect effects of the LF/HF ratio were 0.004, 0.006, and 0.007, accounting for approximately 4.3%, 5.1%, and 3.8% of the total effect.
HB is independently associated with dyslipidemia, an association that is partially mediated by cardiac autonomic imbalance, particularly in younger, female, and non-obese populations.

PMID:
42657818
Bibliographic data and abstract were imported from PubMed on 27 Aug 2026.

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