Micro-arousals during REM and NREM sleep and lipid profile in obstructive sleep apnea: evidence from the shanghai sleep health study.

BACKGROUND

Previous studies showed that obstructive sleep apnea (OSA) is associated with dyslipidemia. However, whether micro-arousals during rapid eye movement (REM) and non-rapid eye movement (NREM) sleep independently associated with dyslipidemia were unknown.

METHODS

4472 participants with OSA-related symptoms were finally included in our cohort. Various sleep variables including micro-arousal index (MAI) were obtained from standard polysomnography (PSG) recordings. Fasting serum lipid levels were assessed at our hospital laboratory. Linear regression models were employed to investigate relationships between micro-arousals in REM and NREM sleep and lipid profile with adjusting for multiple confounding factors.

RESULTS

Fully adjusted models demonstrated a significant dose-dependent positive correlation between the MAI during REM sleep (MAI REM) and lipoprotein(a) (Lp(a)) levels (β = 0.061; P = 0.008), a finding that remained robust in sensitivity analyses (β = 0.068; P = 0.040). Subgroup analyses further revealed that this association was particularly prominent in patients with moderate-to-severe OSA (moderate: β = 0.106, P = 0.046; severe: β = 0.060,P = 0.045) and in male participants (β = 0.075,P = 0.003).

CONCLUSION

MAIREM independently predicted elevated Lp(a) levels (P < 0.01), with peak effects manifested in males and moderate-to-severe OSA patients. The statistical findings regarding the association between REM sleep fragmentation and Lp(a) in our study may offer new insights into the close relationship between OSA and cardiovascular diseases.