MON-299 - Association of Vitamin D Deficiency with Cardiometabolic and Mortality Outcomes in Obstructive Sleep Apnea

OBJECTIVE
Vitamin D deficiency is highly prevalent in obstructive sleep apnea (OSA) and implicated in metabolic dysregulation and cardiovascular disease. This study examined associations between vitamin D deficiency and adverse cardiovascular, metabolic, and mortality outcomes in adults with OSA.

METHODS
This retrospective cohort study utilized the TriNetX Global Collaborative Network spanning 155 healthcare organizations. Adults (≥18 years) with OSA (ICD-10: G47.33) were stratified by serum 25-hydroxyvitamin D3 into deficient (≤12 ng/mL, n=64,205) and sufficient (≥20 ng/mL, n=64,205) cohorts following 1:1 propensity matching. Primary outcomes included all-cause mortality, myocardial infarction, heart failure, pulmonary embolism, chronic kidney disease, hypertension, type 2 diabetes, and cerebrovascular disease over five years. Kaplan-Meier survival analyses with hazard ratios were calculated.

RESULTS
After propensity matching, OSA patients with vitamin D deficiency demonstrated significantly elevated risks. All-cause mortality was 11.8% versus 5.7% (risk ratio 2.06; hazard ratio 2.30; p< 0.001), with five-year survival of 83.0% versus 91.7%. Myocardial infarction occurred in 4.0% versus 2.8% (risk ratio 1.45; HR 1.62; p< 0.001). Heart failure incidence was 8.7% versus 6.4% (risk ratio 1.36; HR 1.51; p< 0.001). Pulmonary embolism risk was 2.1% versus 1.6% (risk ratio 1.32; HR 1.47; p< 0.001). Type 2 diabetes developed in 11.5% versus 10.5% (risk ratio 1.09; HR 1.21; p< 0.001). Cerebrovascular disease occurred in 6.2% versus 5.9% (HR 1.17; p=0.019). Chronic kidney disease and hypertension did not show any significant differences.

DISCUSSION/CONCLUSIONS
In this large, propensity-matched cohort of adults with obstructive sleep apnea, vitamin D deficiency was associated with higher long-term risks of all-cause mortality and several adverse cardiovascular and metabolic outcomes. Deficient vitamin D status was consistently linked with increased incidence of myocardial infarction, heart failure, pulmonary embolism, and type 2 diabetes over five years, while no significant differences were observed for chronic kidney disease or hypertension. Although these associations persisted after extensive matching, the observational design precludes causal inference, and residual confounding cannot be excluded. Vitamin D deficiency may represent a

marker of greater disease burden, metabolic dysfunction, or overall health status in patients with OSA. These findings support further investigation into the role of vitamin D status in risk stratification and highlight the need for prospective, interventional studies to clarify whether vitamin D repletion can meaningfully modify clinical outcomes in this population.

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