Urinary Metabolomic Signatures in Obstructive Sleep Apnea through Targeted Metabolomic Analysis: A Pilot Study

Introduction Obstructive sleep apnea (OSA) is very common sleep problem, and it is associated with serious morbidities such as cardiovascular diseases and metabolic diseases. Overnight polysomnography (PSG) is the gold standard test for OSA, but it is expensive and requires specific facilities and equipment. Thus, novel screening methods are needed for effective diagnosis and follow-up in OSA. Objectives The aims of the study were to investigate the urinary metabolic signatures and identify potential urine markers for OSA using a mass spectrometry (MS)-based assay for targeted metabolomics. \ Methods Urine samples were collected from 48 male subjects who visited a sleep clinic for suspicious OSA. All underwent overnight in-laboratory polysomnography. The Biocrates AbsoluteIDQ p180 kit was used for targeted metabolomics. Results Among the 86 metabolites quantified, three acylcarnitines, one biogenic amine, two glycerophospholipids, and two sphingomyelins were differently expressed in OSA patients [apnea-hypopnea index (AHI) >= 5] compared with control groups (AHI < 5 and/or simple snoring with no other sleep disorders). Additional partial correlation and multivariate logistic regression analysis revealed that longchain acylcarnitine C14:1, symmetric dimethylarginine, and sphingomyelin C18:1 might be potential biomarkers for OSA. Receiver operating characteristic analysis showed favorable predictive properties of these metabolites. Furthermore, a combination of the metabolites exceeding cutoff values yielded further improved sensitivity or specificity. Conclusions MS-based targeted metabolomics identified specific classes of urinary metabolites that were upregulated in OSA patients. Further assessments in large populations are required to clarify the screening values of these metabolite markers.