Hypertension Outperforms Obesity in Predicting Obstructive Sleep Apnea Risk in Non-Obese Chinese Adults: The Added Role of Anxiety in Community Screening
Year: 2026
Type: preprint
Study design: Observational Study
Abstract: Purpose: This study aimed to identify key predictors of Obstructive Sleep Apnea (OSA) risk in Chinese adults with predominantly normal to overweight BMI, and to determine whether anxiety serves as an independent risk marker or mediator in the association between hypertension and OSA risk. Methods: A community‑based cross‑sectional study was conducted among 11,844 adults aged ≥35 years in Guangzhou, China. Hypertension was defined by self‑reported diagnosis or antihypertensive medication use. Anxiety symptoms were assessed using the Zung Self‑Rating Anxiety Scale (SAS). High OSA risk was determined by the Berlin Questionnaire. Group least absolute shrinkage and selection operator (LASSO) regression and path analysis were used to evaluate predictors and mediation effects, adjusting for age, sex, BMI, lifestyle factors, and other psychological measures. Results: The prevalence of hypertension was 29.4%, and 36.5% of participants were classified as high OSA risk. Group LASSO regression identified hypertension as the strongest predictor (odds ratio [OR] = 10.75), while BMI showed a much smaller effect (OR = 1.27). Anxiety was independently associated with OSA risk (OR = 1.07, *p* < 0.001). Path analysis revealed that anxiety mediated only 1.7% of the total hypertension–OSA association, indicating a minor but statistically significant mediating role. Conclusion: In this non‑obese community cohort, hypertension far outperforms BMI in predicting high OSA risk. Anxiety adds modest independent predictive value and may serve as a useful clinical red‑flag indicator, but its mediating effect is small. Integrated screening targeting both vascular and psychological factors is warranted in similar Asian populations.
Source: Research Square
Institution: Guangzhou Center for Disease Control and Prevention
Language: English
Subfield: Physiology (medical)
Field: Medicine
Domain: Health Sciences
Open Access status: green
OpenAlex ID: W7225348355