Metabolic and endocrine status associate with obstructive sleep apnea risk among patients with polycystic ovary syndrome

Study Objectives: Risk of obstructive sleep apnea (OSA) appears to be increased among patients with polycystic ovary syndrome (PCOS), but the underlying physiology is unclear. We sought to identify predictors of OSA risk among patients with PCOS. Methods: A cross-sectional analysis of patients evaluated for PCOS at a single tertiary center from 2017 -2022 was completed. Inclusion criteria included patients 18 -44 years of age who had Rotterdam criteria for PCOS and had completed a Berlin Questionnaire (BQ) for OSA risk assessment. All patients underwent standardized anthropometric, ultrasound, endocrine, and metabolic phenotyping. Results: Of the 572 patients screened during the study period, 309 patients with PCOS met inclusion criteria, and 104 (33.7%) had a high -risk BQ. Those with a high -risk BQ, compared with those without, had significantly ( P < .05) higher waist:hip ratio, low -density -lipoprotein cholesterol, triglycerides, fasting insulin, 2 -hour insulin, fasting glucose, 2 -hour glucose, homeostatic model assessment for insulin resistance, hemoglobin A1C, C -reactive protein, free testosterone, and free androgen index and had lower high -density -lipoprotein cholesterol and sex hormone binding globulin. In multivariable modeling controlling for all significantly differing variables in univariate analyses, hemoglobin A1C ( beta [standard error] 1.05 [0.45], P = .02), C -reactive protein (0.09 [0.04], P = .01), and sex hormone binding globulin ( 20.02 [0.01], P = .02) associated with high -risk BQ. Conclusions: Dysglycemia, inflammation, and androgen status independently associate with predicted OSA risk by BQ. Future studies are needed to comprehensively assess the impact of treatment of OSA on these outcomes among patients with PCOS to better clarify the directionality and clinical implications of these associations.