Alterations of cholesterol synthesis and absorption in obstructive sleep apnea: Influence of obesity and disease severity

Aleksandra Zeljković*, Ana Milojević, Sandra Vladimirov, Marija Zdravković, Lidija Memon, Milica Brajković, Vera Gardijan, Tamara Gojković, Aleksandra Stefanović, Milica Miljković-Trailović, Vesna Spasojević-Kalimanovska, Ana Ninić

*Corresponding author for this work

Research output: Contribution to journalArticleResearchpeer-review

3 Citations (Scopus)


Background and aims: Obstructive sleep apnea (OSA) is closely linked to obesity and related adverse metabolic changes, including dyslipidemia. However, it is not clear whether OSA is an independent contributing factor to dyslipidemia, or the observed association is a reflection of a concomitant presence of obesity. Additionally, dyslipidemia is usually evaluated through measurement of parameters of routine lipid status, while more precise evaluation of lipid homeostasis is rarely performed in OSA. In this study, we analyzed markers of cholesterol synthesis and absorption in patients with OSA with respect to the presence of obesity and the disease severity. Methods and results: This study enrolled 116 OSA patients. Concentrations of non-cholesterol sterols (NCS), measured by LC-MS/MS, were used as markers of cholesterol synthesis and absorption. Apnea-hypopnea index (AHI) and oxygen saturation (SaO2) were utilized as markers of OSA severity. Serum lipid status parameters were determined by routine enzymatic methods. Markers of cholesterol synthesis were increased (P = 0.005), whilst markers of cholesterol absorption decreased (P = 0.001) in obese OSA patients. Cholesterol synthesis/absorption ratio was elevated in obese subjects (P < 0.001). Concentration of cholesterol synthesis marker lathosterol was significantly higher in subjects with severe OSA (P = 0.014) and we observed a trend of decreased cholesterol absorption in these patients. AHI was revealed as an independent determinant of lathosterol concentration (P = 0.022). Conclusions: Our results suggest that the presence of obesity and severe forms of OSA is characterized by elevated endogenous cholesterol synthesis. AHI was singled out as an independent determinant of the serum level of cholesterol synthesis marker lathosterol.

Original languageEnglish
Pages (from-to)2848-2857
Number of pages10
JournalNutrition, Metabolism and Cardiovascular Diseases
Issue number12
Publication statusPublished - Dec 2022
Externally publishedYes


  • Apnea-hypopnea index
  • Cholesterol synthesis and absorption
  • Dyslipidemia
  • Non-cholesterol sterols
  • Obesity
  • Obstructive sleep apnea


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