Body Roundness Index Versus Body Mass Index: Differential Associations With Obstructive Sleep Apnea Syndrome and All‐Cause Mortality in US Adults Aged 20 Years and Older
Year: 2025
Type: article
Abstract: BACKGROUND: Being obese considerably elevates the risk of both obstructive sleep apnea syndrome (OSAS) and mortality. Although body mass index (BMI) is a common measure, it neglects visceral adiposity, a critical factor in the development of cardiometabolic and respiratory dysfunction. By integrating waist circumference and height, the body roundness index (BRI) delivers a more accurate evaluation of central fat distribution, potentially improving the prediction of OSAS and mortality. METHODS: We analyzed data from 13,854 US adults aged ≥20 years from the NHANES 2005-2008 and 2015-2018 cycles. Using multivariable logistic and Cox regression models, along with restricted cubic spline and subgroup analyses, the connections of BRI and BMI with OSAS and all-cause mortality were examined, and ROC curves were employed to compare predictive performance. RESULTS: Both BRI and BMI were significantly associated with increased OSAS risk, with stronger associations observed for BRI (adjusted odds ratio [OR] = 3.060, 95% confidence interval [CI]: 2.880-3.251, p < 0.001) than for BMI (adjusted OR = 1.573, 95% CI: 1.535-1.612, p < 0.001). In OSAS patients, BRI was positively associated with all-cause mortality (adjusted hazard ratio [HR] = 1.087, 95% CI: 1.036-1.141, p < 0.001; Q4 vs. Q1: HR = 1.423, 95% CI: 1.073-1.887, p = 0.014), while BMI showed an inverse crude association that became marginally positive after adjustment (adjusted HR = 1.021, 95% CI: 1.001-1.040, p = 0.038; Q4 vs. Q1: HR = 1.378, 95% CI: 0.966-1.964, p = 0.037). BRI demonstrated superior predictive value for mortality (area under the curve [AUC] = 0.610) compared to BMI (AUC = 0.521; p < 0.001), despite comparable performance for OSAS prediction (BRI AUC = 0.793 vs. BMI AUC = 0.790; p = 0.236). CONCLUSION: BRI and BMI showed comparable ability to predict OSAS risk; however, BRI demonstrated superior value in mortality stratification, emphasizing its clinical significance for assessing visceral fat-related prognosis. Because OSAS was identified using a validated questionnaire rather than polysomnography, minor classification errors may exist, warranting cautious interpretation of the findings.
Source: Brain and Behavior
DOI: 10.1002/brb3.71109
Authors: Xiaodong Chen, Xianglian Chen, Hongwei Liu, Minheng Zhang
Institutions: Shanxi Medical University, Taiyuan Central Hospital
Language: English
Subfield: Physiology
Field: Medicine
Domain: Health Sciences
Open Access status: gold
Estimated APC paid: $3,630
OpenAlex ID: W4416936960