Association between Non-High-Density Lipoprotein Cholesterol to High-Density Lipoprotein Cholesterol Ratio (NHHR) and Obstructive Sleep Apnea (OSA): A Cross-Sectional Study of the U.S. Population from 2015-2018

Objective: The relationship between non-high-density lipoprotein cholesterol to high-density lipoprotein cholesterol ratio (NHHR) and the prevalence of obstructive sleep apnea (OSA) remains unclear. This investigation examines the potential relationship between NHHR and the prevalence of OSA in the broader, non-pregnant United States population. Methods: This investigation utilized data from the NHANES 2015-2018 dataset, employing a suite of statistical techniques, including univariate and multivariate logistic regression models, curve fitting, threshold effect analysis, subgroup analysis, and interaction tests, to examine the association between NHHR and the prevalence of OSA. Results: The research encompassed 5113 subjects, finding that nearly half (49.27%) were affected by Obstructive Sleep Apnea (OSA). The analysis used multivariate logistic regression to reveal a statistically significant positive association between NHHR and OSA. This was observed when NHHR was considered a continuous variable (OR = 1.07, 95% CI: 1.01 - 1.13, p = 0.0188) across all models, including the crude model, model 1, and model 2. Furthermore, when NHHR was categorized into thirds, the highest tertile demonstrated a notably stronger correlation with OSA compared to the lowest tertile in the fully adjusted model 2 (OR = 1.45, 95% CI: 1.20 - 1.76, p= 0.0001). Subgroup analysis highlighted that NHHR had a more pronounced ability to predict the risk of OSA in females (p Conclusion: Our understanding of the prevention and treatment of OSA may be improved by more research on NHHR, as our cross-sectional study suggested a potential nonlinear relationship between NHHR and OSA prevalence. To validate these results, more study is necessary.