Long-Term Cardiovascular Outcomes of Obstructive Sleep Apnea by Adiposity Phenotype: A Korean Nationwide Cohort Study

Abstract Background Obstructive sleep apnea (OSA) has been identified as an independent determinant of cardiovascular risk and the prevalence rate is steadily increasing. We aimed to assess differences in clinical characteristics and long-term cardiovascular outcomes between the clinically suspected OSA and control groups across detailed eight subgroups according to body mass index (BMI) and waist circumference (WC) with a propensity score–matched analysis using the entire Korean National Health Insurance (KNHI) database. Methods A total of 184,879 subjects with OSA were enrolled from the KNHI database between 2010 and 2021. Participants were classified into eight subgroups according to baseline BMI and WC. They were compared with control by 1:2 Propensity Score matching and followed up until 2023 for the occurrence of cardiovascular events. Results Among the total study population, the mean age of the OSA group was 47.2 years and several metabolic risk factors were significantly more prevalent in the OSA group. OSA HR / Control HR was significantly higher for angina in the severe obesity with high waist circumference (HWC) group. For atrial fibrillation, this ratio was significantly higher in both the underweight with low waist circumference (LWC) group and the severe obesity with HWC group. It was significantly higher for composite end point in the underweight with LWC group. Conclusions Higher cardiovascular outcomes were observed in subgroups at both extreme phenotypes of adiposity. Both the underweight with LWC group and the severe obesity with HWC group were significantly associated with higher incidence of atrial fibrillation.