Menopause and obstructive sleep apnea: revealing an independent mediating role of visceral fat beyond body mass index.
Level 4 - case-series / case-control
Cross-sectional survey analysis
PubMed 39863851 · doi:10.1186/s12902-025-01850-2
What was done
A cross-sectional analysis was performed on 1,459 women (1,188 premenopausal and 271 postmenopausal) from the 2015-2016 National Health and Nutrition Examination Survey (NHANES). Body fat distribution was quantified using dual-energy X-ray absorptiometry. Menopausal status and obstructive sleep apnea (OSA) symptoms were determined by questionnaire. Weighted multivariable regression and mediation analyses were conducted to assess the association between menopausal status, visceral fat mass, and OSA symptoms, adjusting for body mass index (BMI) and other confounders, supplemented by an age-matched analysis.
What was found
OSA symptoms were present in 36.01% of premenopausal and 53.39% of postmenopausal women. After adjustment for BMI and confounders, menopausal status remained associated with higher OSA symptom prevalence (OR = 1.57; 95% CI: 1.16, 2.13) and increased visceral fat mass (beta = 0.12; 95% CI: 0.07, 0.17). Visceral fat mass was significantly associated with OSA symptoms (OR = 3.79; 95% CI: 1.61, 8.94) and mediated 29.76% of the effect of menopausal status on OSA symptoms. In age-matched analysis, postmenopausal women had higher visceral fat mass (0.63 kg vs. 0.52 kg, P = 0.02) and higher OSA symptom prevalence (68.3% vs. 45.7%, P = 0.02) without a significant difference in BMI (P > 0.05).
Why it matters
This study demonstrates that visceral fat accumulation accounts for nearly 30% of the heightened OSA symptom risk observed after menopause, showing that body fat distribution confers risk beyond what is captured by standard BMI.
Limits
The study is cross-sectional, precluding causal or temporal conclusions. OSA status was assessed via questionnaire rather than objective polysomnography. The sample included substantially fewer postmenopausal women (n = 271) than premenopausal women (n = 1,188), and unmeasured confounders such as specific circulating sex hormone levels were not evaluated.
Cited by
- supports The prevalence of sleep apnea in post-menopausal women is approximately 25%.