Interrelationships Among Apolipoprotein B/Apolipoprotein A-I Ratio, Insulin Resistance and Obstructive Sleep Apnea: A Large-Scale Observational Study

Abstract

Background: The apolipoprotein B/apolipoprotein A-I (ApoB/ApoA-I) ratio has been recognized as a new predictor of cardiovascular diseases (CVD). However, the interrelationships between the ApoB/ApoA-I ratio and common CVD risk factor [insulin resistance, obstructive sleep apnea (OSA)] remain unclear. Methods: A total of 6,433 suspected OSA consecutively admitted to our sleep center were screened and 4,813 were included. Anthropometric, fasting biochemical, and polysomnographic parameters were collected. The relationships between insulin resistance, OSA risk, and the ApoB/ApoA-I ratio were evaluated through logistic regressions analysis and restricted cubic spline (RCS) analysis. Mediation analyses were qualified to assess the interrelationships. Results: Patients with OSA had a lower level of ApoA-I and a higher ApoB and ApoB/ApoA-I ratio. The fully adjusted odds ratios (95% confidence intervals) for both OSA [1 (reference), 1.406 (1.129-1.751), 1.556 (1.236-1.958), and 1.943 (1.508-2.505)] and insulin resistance [1 (reference), 1.424 (1.176-1.725), 1.948 (1.359-1.998), 2.019(1.658-2.459)] increased from the first to the fourth quartiles of the ApoB/ApoA-I ratio. Finally, the RCS mapped a nonlinear dose-effect relationship between the ApoB/ApoA-I ratio and risk of insulin resistance and OSA. OSA was also independently associated with insulin resistance. Mediation analyses showed insulin resistance explain 7.4%, 3.6% and 10.8% of the association between apnea-hypopnea index, oxygen desaturation index, micro-arousal index and ApoB/ApoA-I ratio, respectively. Conclusions: Our study revealed that ApoB/ApoA-I ratio was positively associated with an increased risk for insulin resistance and OSA severity. Insulin resistance may serve as a potential mediator in OSA-related lipoprotein disorders and further increase CVD risk. Funding Statement: This study was supported by grants-in-aid from National Key R&D Program of China (2017YFC0112500), National Natural Science Foundation of China (81770987), Shanghai Sailing Program (17YF1414300), multi-center clinical research project from school of medicine, Shanghai Jiao Tong University (DLY201502) and Shanghai Shen-Kang Hospital Management Center Project of Shanghai (SHDC12015101). Declaration of Interests: The authors declare that they have no competing interests. Ethics Approval Statement: The ethics committee of Shanghai Jiao Tong University Affiliated Sixth People’s Hospital approved this study according to Helsinki Declaration II. All the participants have given the informed consent before taking part in the study.