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. 2025 Aug 1;21(8):1371-1378.
doi: 10.5664/jcsm.11698.

Effect of age on the association of obstructive sleep apnea with metabolic syndrome among obese and nonobese adults

Slobodanka Pejovic  1 , Alexandros N Vgontzas  1 , Julio Fernandez-Mendoza  1 , Fan He  2 , Yun Li  3   4 , Edward O Bixler  1
Affiliations

Effect of age on the association of obstructive sleep apnea with metabolic syndrome among obese and nonobese adults

Slobodanka Pejovic et al. J Clin Sleep Med. .

Abstract

Study objectives: It has been described a bi-directional association between obstructive sleep apnea (OSA) and metabolic syndrome (MetS), both promoting atherosclerosis and cardiovascular disease. Given that cardiometabolic comorbidities associated with OSA tend to diminish with age, in this study we examined whether the association of OSA with MetS is modified by age and body weight.

Methods: We studied 1,741 adults from the Penn State Adult Cohort (age 20-88 years) who underwent a 1-night polysomnography, clinical history, and physical examination in a cross-sectional design. The presence of OSA was defined as an apnea-hypopnea index ≥ 15 events/h. Outcome variables include the 5 MetS components (obesity [≥ 30kg/m2], hypertension [≥ 130/85 mm Hg], hyperglycemia [fasting blood sugar (FBS) ≥ 100 mg/dL], hypercholesterolemia [≥ 200 mg/dL], and hypertriglyceridemia [≥ 150 mg/dL]). Logistic regression models examined the association of OSA with MetS components adjusting for confounders.

Results: There was a significant interaction between OSA and age on MetS. In young and middle-aged individuals (< 60 years old) but not in older individuals, OSA was significantly associated with MetS and its individual components, ie, hypertension (odds ratio [OR] = 3.85, 95% confidence interval [CI] = 1.95-7.63), hyperglycemia (OR = 5.62, 95% CI = 2.74-11.53), hypercholesterolemia (OR = 5.99, 95% CI = 2.36-15.21), and hypertriglyceridemia (OR = 4.75, 95% CI = 2.30-9.90). The association of OSA with body mass index was stronger in the young and middle-aged vs older group (OR = 6.03, 95% CI = 3.08-11.78 vs 2.47, 95% CI = 1.23-4.94, respectively). Similar age-related modifications were observed in nonobese individuals.

Conclusions: The strong association of OSA with MetS in young and middle-aged obese and nonobese adults, but not in older adults, suggests that MetS is key to the pathogenesis of OSA in young and middle-aged adults and should be a treatment priority.

Citation: Pejovic S, Vgontzas AN, Fernandez-Mendoza J, He F, Li Y, Bixler EO. Effect of age on the association of obstructive sleep apnea with metabolic syndrome among obese and nonobese adults. J Clin Sleep Med. 2025;21(8):1371-1378.

Keywords: cohort study; metabolic syndrome; sleep apnea; sleep-disordered breathing.

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Conflict of interest statement

All authors have seen and approved the manuscript. Work was performed at the Sleep Research & Treatment Center, Penn State Health Milton S. Hershey Medical Center, The Pennsylvania State University, College of Medicine, Hershey, PA. This study was supported partially by National Heart Lung and Blood Institute Grants ROl HL40916 (principal investigator [PI] E. O. Bixler, co-investigator [Co-I] A. N. Vgontzas) and HLS193 (PI E. O. Bixler, Co-I A. N. Vgontzas). The other authors of the study report no financial support. The authors report no conflicts of interest.

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