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.
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.
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.
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).
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.
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.
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).
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.