Abstract
Obesity plays a significant role in the development of obstructive sleep apnea (OSA). The primary aim of this research was to compare 3 key obesity metrics: waist-to-height ratio (WHtR), body roundness index (BRI), and a body shape index (ABSI), to assess their correlation with OSA. Identifying OSA at an early stage can lead to more favorable treatment outcomes. This cross-sectional investigation leveraged data from the National Health and Nutrition Examination Survey collected during 2 periods: 2005 to 2008 and 2015 to 2018. The primary objective was to examine the relationships among different levels of WHtR, BRI, and ABSI in relation to OSA-related symptoms using multivariate logistic regression models. A range of analytical techniques, including subgroup analyses and threshold effect evaluations, were applied. To enhance the robustness of our findings concerning the associations between WHtR, BRI, ABSI, and OSA-related symptoms, we accounted for a variety of potential confounding variables, such as demographic factors, lifestyle habits, and the presence of comorbidities including diabetes, hypertension, and cardiovascular disease. In a cohort of 15,177 participants, 52.29% were classified within OSA-related symptoms group. The areas under the curve for WHtR and BRI in predicting OSA were both 0.616 (95% CI: 0.607-0.626), with optimal thresholds identified at 0.356 for WHtR and 0.351 for BRI. When analyzed by quartiles, participants in higher WHtR and BRI quartiles showed progressively higher odds of OSA-related symptoms, demonstrating a clear dose-response relationship. Threshold effect analyses based on Z-score standardized values indicated inflection points of 3.53 for BRI and 0.50 for WHtR, with participants above these thresholds showing a modestly higher risk of OSA-related symptoms. The relationship between BRI and WHtR with OSA-related symptoms exhibited a nonlinear pattern, as indicated by restricted cubic spline. However, no significant correlation was observed between ABSI and OSA-related symptoms. This study provides compelling evidence that both the BRI and WHtR exhibit a significant positive association with OSA-related symptoms, characterized by a non-linear relationship.