Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Article
  • Published:

Epidemiology and Population Health

Relationship of serum 25-hydroxyvitamin D, obesity with new-onset obstructive sleep apnea

International Journal of Obesity volume 48, pages 218–223 (2024)Cite this article

Subjects

Abstract

Objective

The prospective association between vitamin D and obstructive sleep apnea (OSA) remains uncertain. We aimed to assess the association between serum 25-hydroxyvitamin D (25(OH)D), a major circulating form of vitamin D, and new-onset OSA, and examine the modifying effect of obesity.

Materials and methods

This prospective cohort study included 444,975 participants from UK Biobank without prior OSA. The primary outcome was new-onset OSA.

Results

During a median follow-up duration of 12.0 years, 6051 (1.4%) participants occurred new-onset OSA. Overall, there was an inverse relation of serum 25(OH)D concentrations with the risk of new-onset OSA (per SD increment, HR, 0.92; 95%CI: 0.89–0.95). In the analysis of the interactions of serum 25(OH)D with the combination of BMI (<25, 25- < 30, and ≥30 kg/m2) and waist circumference (WC) (<90 and ≥90 cm) categories on new-onset OSA, the significantly inverse association of serum 25(OH)D and new-onset OSA was mainly found in participants with both BMI ≥ 25 kg/m2 and WC ≥ 90 cm (BMI 25–30 kg/m2 and WC ≥ 90 cm: per SD increment, HR, 0.90; 95%CI: 0.84–0.95; BMI ≥ 30 kg/m2 and WC ≥ 90 cm: per SD increment, HR, 0.85; 95%CI: 0.81-0.88), but not in other four groups with BMI < 25 kg/m2 or WC < 90 cm (P -interaction = 0.004).

Conclusions

There was an inverse relation of serum 25(OH)D with the risk of new-onset OSA in participants with both BMI ≥ 25 kg/m2 and WC ≥ 90 cm. Our findings suggest the importance of maintaining a higher serum 25(OH)D concentration for primary prevention of OSA in a population with obesity.

This is a preview of subscription content, access via your institution

Access options

Buy this article

  • Purchase on Springer Link
  • Instant access to full article PDF
Buy now

Prices may be subject to local taxes which are calculated during checkout

Fig. 1: Restricted cubic splines of serum 25(OH)D with new-onset obstructive sleep apnea.
Fig. 2: Interaction of serum 25(OH)D (Per SD increment) and obesity on new-onset obstructive sleep apnea.

Similar content being viewed by others

Data availability

The UK Biobank data are available on application to the UK Biobank, and the analytic methods and study materials that support the findings of this study will be available from the corresponding authors on request.

References

  1. Veasey SC, Rosen IM. Obstructive sleep apnea in adults. N Engl J Med. 2019;380:1442–9.

    Article  PubMed  Google Scholar 

  2. Peppard PE, Young T, Barnet JH, Palta M, Hagen EW, Hla KM. Increased prevalence of sleep-disordered breathing in adults. Am J Epidemiol. 2013;177:1006–14.

    Article  PubMed  PubMed Central  Google Scholar 

  3. Arnardottir ES, Bjornsdottir E, Olafsdottir KA, Benediktsdottir B, Gislason T. Obstructive sleep apnoea in the general population: highly prevalent but minimal symptoms. Eur Respir J. 2016;47:194–202.

    Article  PubMed  Google Scholar 

  4. Rowley JA, Lareau S, Fahy BF, Garvey C, Sockrider M. What is obstructive sleep apnea in adults? Am J Respir Crit Care Med. 2017;196:P1–P2.

    Article  PubMed  Google Scholar 

  5. Yeghiazarians Y, Jneid H, Tietjens JR, Redline S, Brown DL, El-Sherif N, et al. Obstructive sleep apnea and cardiovascular disease: a scientific statement from the american heart association. Circulation. 2021;144:e56–e67.

    Article  PubMed  CAS  Google Scholar 

  6. Kulie T, Groff A, Redmer J, Hounshell J, Schrager S. Vitamin D: an evidence-based review. J Am Board Fam Med. 2009;22:698–706.

    Article  PubMed  Google Scholar 

  7. Holick MF. High prevalence of vitamin D inadequacy and implications for health. Mayo Clin Proc. 2006;81:353–73.

    Article  PubMed  CAS  Google Scholar 

  8. Archontogeorgis K, Nena E, Papanas N, Steiropoulos P. The role of vitamin D in obstructive sleep apnoea syndrome. Breathe (Sheff). 2018;14:206–15.

    Article  PubMed  Google Scholar 

  9. Li X, He J, Yun J. The association between serum vitamin D and obstructive sleep apnea: an updated meta-analysis. Respir Res. 2020;21:294.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  10. Neighbors CLP, Noller MW, Song SA, Zaghi S, Neighbors J, Feldman D, et al. Vitamin D and obstructive sleep apnea: a systematic review and meta-analysis. Sleep Med. 2018;43:100–8.

    Article  PubMed  Google Scholar 

  11. Upala S, Sanguankeo A. Association between 25-Hydroxyvitamin D and obstructive sleep apnea: a systematic review and meta-analysis. J Clin Sleep Med. 2015;11:1347.

    Article  PubMed  PubMed Central  Google Scholar 

  12. Yassa OY, Domac SF, Kenangil G. Serum vitamin D status does not correlate with the severity of obstructive sleep apnea in male adults: a controlled study design with minimized factors influencing serum vitamin D levels. Int J Vitam Nutr Res. 2020;90:470–6.

    Article  PubMed  CAS  Google Scholar 

  13. Ma D, Zheng X, Dong L, Zheng C, Chen Y, Chen Z, et al. The relationship of serum 25-Hydroxyvitamin-D level with severity of obstructive sleep apnea in patients with Type 2 diabetes mellitus. Diabetes Metab Syndr Obes. 2020;13:1391–8.

    Article  PubMed  PubMed Central  Google Scholar 

  14. Stefan N, Häring HU, Hu FB, Schulze MB. Metabolically healthy obesity: epidemiology, mechanisms, and clinical implications. Lancet Diabetes Endocrinol. 2013;1:152–62.

    Article  PubMed  Google Scholar 

  15. Al Lawati NM, Patel SR, Ayas NT. Epidemiology, risk factors, and consequences of obstructive sleep apnea and short sleep duration. Prog Cardiovasc Dis. 2009;51:285–93.

    Article  PubMed  Google Scholar 

  16. Wortsman J, Matsuoka LY, Chen TC, Lu Z, Holick MF. Decreased bioavailability of vitamin D in obesity. Am J Clin Nutr. 2000;72:690–3.

    Article  PubMed  CAS  Google Scholar 

  17. Pereira-Santos M, Costa PR, Assis AM, Santos CA, Santos DB. Obesity and vitamin D deficiency: a systematic review and meta-analysis. Obes Rev. 2015;16:341–9.

    Article  PubMed  CAS  Google Scholar 

  18. Sudlow C, Gallacher J, Allen N, Beral V, Burton P, Danesh J, et al. UK biobank: an open access resource for identifying the causes of a wide range of complex diseases of middle and old age. PLoS Med. 2015;12:e1001779.

    Article  PubMed  PubMed Central  Google Scholar 

  19. Elliott P, Peakman TC, UK Biobank. The UK Biobank sample handling and storage protocol for the collection, processing and archiving of human blood and urine. Int J Epidemiol. 2008;3:234–44.

    Article  Google Scholar 

  20. Eastwood SV, Mathur R, Atkinson M, Brophy S, Sudlow C, Flaig R, et al. Algorithms for the capture and adjudication of prevalent and incident diabetes in UK biobank. PLoS One. 2016;11:e0162388.

    Article  PubMed  PubMed Central  Google Scholar 

  21. Zhang YB, Chen C, Pan XF, Guo J, Li Y, Franco OH, et al. Associations of healthy lifestyle and socioeconomic status with mortality and incident cardiovascular disease: two prospective cohort studies. BMJ. 2021;373:n604.

    Article  PubMed  PubMed Central  Google Scholar 

  22. Bycroft C, Freeman C, Petkova D, Band G, Elliott LT, Sharp K, et al. The UK Biobank resource with deep phenotyping and genomic data. Nature. 2018;562:203–9.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  23. Campos AI, García-Marín LM, Byrne EM, Martin NG, Cuéllar-Partida G, Rentería ME. Insights into the aetiology of snoring from observational and genetic investigations in the UK Biobank. Nat Commun. 2020;11:817.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  24. Holick MF, Binkley NC, Bischoff-Ferrari HA, Gordon CM, Hanley DA, Heaney RP, et al. Evaluation, treatment, and prevention of vitamin D deficiency: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab. 2011;96:1911–30.

    Article  PubMed  CAS  Google Scholar 

  25. Remelli F, Vitali A, Zurlo A, Volpato S. Vitamin D deficiency and sarcopenia in older persons. Nutrients. 2019;11:2861.

    Article  PubMed  PubMed Central  Google Scholar 

  26. Dempsey JA, Veasey SC, Morgan BJ, O’Donnell CP. Pathophysiology of sleep apnea. Physiol Rev. 2010;90:47–112.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  27. McNicholas WT. Obstructive sleep apnea and inflammation. Prog Cardiovasc Dis. 2009;51:392–9.

    Article  PubMed  CAS  Google Scholar 

  28. Song J, Li Y, An R. Vitamin D restores angiogenic balance and decreases tumor necrosis factor-α in a rat model of pre-eclampsia. J Obstet Gynaecol Res. 2017;43:42–49.

    Article  PubMed  CAS  Google Scholar 

  29. Toujani S, Kaabachi W, Mjid M, Hamzaoui K, Cherif J, Beji M. Vitamin D deficiency and interleukin-17 relationship in severe obstructive sleep apnea-hypopnea syndrome. Ann Thorac Med. 2017;12:107–13.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  30. Medrano M, Carrillo-Cruz E, Montero I, Perez-Simon JA. Vitamin D: effect on haematopoiesis and immune system and clinical applications. Int J Mol Sci. 2018;19:2663.

    Article  PubMed  PubMed Central  Google Scholar 

  31. Wondie A, Taderegew MM, Girma B, Getawey A, Tsega D, Terefe TF, et al. Obstructive sleep apnea risk and its associated factors among type 2 diabetes mellitus patients at wolkite university specialized hospital, Wolkite, Southern Ethiopia, 2021. A comparative cross-sectional study. Diabetol Metab Syndr. 2022;14:157.

    Article  PubMed  PubMed Central  Google Scholar 

  32. Kang HH, Kang JY, Ha JH, Lee J, Kim SK, Moon HS, et al. The associations between anthropometric indices and obstructive sleep apnea in a Korean population. PLoS One. 2014;9:e114463.

    Article  PubMed  PubMed Central  Google Scholar 

  33. Lagunova Z, Porojnicu AC, Lindberg F, Hexeberg S, Moan J. The dependency of vitamin D status on body mass index, gender, age and season. Anticancer Res. 2009;29:3713–20.

    PubMed  CAS  Google Scholar 

  34. Parikh SJ, Edelman M, Uwaifo GI, Freedman RJ, Semega-Janneh M, Reynolds J, et al. The relationship between obesity and serum 1,25-dihydroxy vitamin D concentrations in healthy adults. J Clin Endocrinol Metab. 2004;89:1196–9.

    Article  PubMed  CAS  Google Scholar 

  35. Jehan S, Zizi F, Pandi-Perumal SR, Wall S, Auguste E, Myers AK, et al. Obstructive sleep apnea and obesity: implications for public health. Sleep Med Disord. 2017;1:00019.

    PubMed  PubMed Central  Google Scholar 

  36. Saltiel AR, Olefsky JM. Inflammatory mechanisms linking obesity and metabolic disease. J Clin Invest. 2017;127:1–4.

    Article  PubMed  PubMed Central  Google Scholar 

  37. Jorde R, Sneve M, Hutchinson M, Emaus N, Figenschau Y, Grimnes G. Tracking of serum 25-hydroxyvitamin D levels during 14 years in a population-based study and during 12 months in an intervention study. Am J Epidemiol. 2010;171:903–8.

    Article  PubMed  Google Scholar 

  38. Hamaoka T, Murai H, Takata S, Hirai T, Sugimoto H, Mukai Y, et al. Different prognosis between severe and very severe obstructive sleep apnea patients; five year outcomes. J Cardiol. 2020;76:573–9.

    Article  PubMed  Google Scholar 

Download references

Acknowledgements

This research uses data from the UK Biobank. The authors would be willing to thanks the UK Biobank participants. This research has been conducted using the UK Biobank Resource under Application Number 73201.

Funding

The study was supported by the National Key Research and Development Program [2022YFC2009600, 2022YFC2009605], the National Natural Science Foundation of China [81973133, 81730019]. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

Author information

Authors and Affiliations

  1. Division of Nephrology, Nanfang Hospital, Southern Medical University; National Clinical Research Center for Kidney Disease; State Key Laboratory of Organ Failure Research; Guangdong Provincial Institute of Nephrology; Guangdong Provincial Key Laboratory of Renal Failure Research, Guangzhou, 510515, China

    Yuanyuan Zhang, Yanjun Zhang, Ziliang Ye, Chun Zhou, Sisi Yang, Mengyi Liu, Panpan He, Xiaoqin Gan & Xianhui Qin

Authors
  1. Yuanyuan Zhang
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Yanjun Zhang
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Ziliang Ye
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Chun Zhou
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Sisi Yang
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Mengyi Liu
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Panpan He
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Xiaoqin Gan
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Xianhui Qin
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

Yuanyuan Z and XQ designed the research, conducted the research, Yuanyuan Z and Yanjun Z performed the data management and statistical analyses. Yuanyuan Z and XQ wrote the manuscript. XQ had primary responsibility for final content. All authors reviewed/edited the manuscript for important intellectual content, and approved the final manuscript.

Corresponding author

Correspondence to Xianhui Qin.

Ethics declarations

Competing interests

The authors declare no competing interests.

Additional information

Publisher’s note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Supplementary information

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Zhang, Y., Zhang, Y., Ye, Z. et al. Relationship of serum 25-hydroxyvitamin D, obesity with new-onset obstructive sleep apnea. Int J Obes 48, 218–223 (2024). https://doi.org/10.1038/s41366-023-01402-5

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/s41366-023-01402-5

Search

Advanced search

Quick links