Association between sex steroid hormones and obstructive sleep apnea among US adults: Data from the 2015 to 2016 National Health and Nutrition Examination Survey.

This study aimed to explore the association between serum steroid hormones (testosterone, estrogen), sex hormone-binding globulin (SHBG) levels, and the risk of obstructive sleep apnea (OSA) among adults in the United States, as well as to evaluate the potential utility of these biomarkers for OSA risk screening. Data were collected from the 2015 to 2016 National Health and Nutrition Examination Survey, including 3331 adults aged 20 years or older. OSA symptoms were assessed via self-reported questionnaires. Serum concentrations of testosterone, estrogen, and SHBG were measured. Sample-weighted logistic regression was used to investigate associations between hormone indicators and OSA risk, with restricted cubic spline models to check for nonlinear relationships. Subgroup analyses tested the robustness of the associations. Receiver operating characteristic curves and area under the curve were used to evaluate the screening utility of testosterone and SHBG. Among the 3331 participants, 1674 were classified as having OSA. Univariate analysis showed that higher testosterone was associated with increased OSA risk, but after adjusting for confounders, testosterone was inversely related to OSA risk (OR = 0.69, 95% confidence interval: 0.54-0.90), with a nonlinear threshold effect. Lower SHBG levels were significantly associated with a higher risk of OSA (OR = 0.71, 95% confidence interval: 0.59-0.85), a finding that remained robust across multiple models and subgroup analyses. Receiver operating characteristic analysis showed that ln(SHBG) had limited discriminatory power for OSA screening (area under the curve, AUC = 0.595). Estrogen levels were not significantly associated with OSA risk. Lower SHBG levels are significantly associated with increased OSA risk. While its standalone value is limited, SHBG may serve as a complementary biomarker in multifactor OSA risk assessment. The testosterone-OSA relationship appears complex, suggesting clinical use should account for multiple influencing factors. Future research should integrate multidimensional biomarkers to optimize early detection and risk assessment for OSA.