METS-IR is significantly associated with hypertension and resistant hypertension in patients with severe OSA, independent of BMI, and demonstrates superior discriminative accuracy compared to BMI or TG/HDL ratio alone.
Key Findings
Results
Elevated METS-IR levels were significantly associated with higher prevalence of both hypertension and resistant hypertension in OSA patients.
Study included 680 adults with OSA diagnosis from 2020–2022 in a retrospective cohort design.
Participants were stratified into quartiles according to their METS-IR scores.
METS-IR incorporates BMI, fasting blood glucose, triglycerides, and HDL-C as components.
Multivariate logistic regression was used, adjusting for sex, lifestyle, and OSA-related variables.
Results
In patients with severe OSA, there was a robust, linear dose-response relationship between METS-IR and risks of both hypertension and resistant hypertension.
The p-trend for the dose-response relationship was < 0.01 in the severe OSA subgroup.
The association was independent of BMI after full adjustment.
In the non-severe OSA group, associations were attenuated and did not exhibit a significant linear trend after full adjustment.
Subgroup analyses were conducted to compare associations between severe and non-severe OSA cohorts.
Results
METS-IR achieved the highest discriminative accuracy for hypertension among the markers tested, with an AUC of 0.745.
AUC for METS-IR in predicting hypertension was 0.745, significantly higher than BMI (AUC 0.729) and TG/HDL ratio (AUC 0.636).
All pairwise comparisons were statistically significant (all p < 0.05).
ROC curve analysis was used to compare discriminative performance across markers.
Results
METS-IR demonstrated superior discriminative ability for resistant hypertension compared to BMI and TG/HDL ratio.
AUC for METS-IR in predicting resistant hypertension was 0.754.
This was higher than BMI (AUC 0.746) and TG/HDL ratio (AUC 0.610).
The TG/HDL ratio showed notably lower discriminative ability for both outcomes compared to the other two markers.
Methods
Post hoc power analyses confirmed that analyses across all groups were adequately powered to detect the observed effect sizes.
Power analyses were conducted across the total cohort, the severe OSA subgroup, and the non-severe OSA subgroup.
All groups exceeded the 80% power threshold.
The authors described the results as 'adequately powered.'
Results
The association between METS-IR and hypertension outcomes was attenuated and non-significant in patients with non-severe OSA after full covariate adjustment.
In the non-severe OSA group, no significant linear trend was observed after full adjustment.
This contrasts with the significant dose-response relationship seen in the severe OSA group (p-trend < 0.01).
OSA severity appears to modify the relationship between METS-IR and hypertension risk.
What This Means
This research suggests that a metabolic measure called METS-IR — which combines body weight (BMI), blood sugar, triglycerides, and HDL ('good') cholesterol into a single score — is strongly linked to both regular high blood pressure (hypertension) and treatment-resistant high blood pressure in people with obstructive sleep apnea (OSA). The study followed 680 adults diagnosed with OSA between 2020 and 2022, and found that as METS-IR scores increased, so did the likelihood of having hypertension or hard-to-treat hypertension. This relationship was particularly clear and consistent in people with severe OSA, where higher METS-IR scores showed a step-by-step increase in risk. In people with milder OSA, the link was weaker and less reliable.
When comparing METS-IR to other commonly used measures like BMI alone or the triglyceride-to-HDL ratio, METS-IR was better at identifying who had hypertension or resistant hypertension. For example, METS-IR's accuracy score (AUC) was 0.745 for hypertension and 0.754 for resistant hypertension, outperforming both BMI and the triglyceride-to-HDL ratio. This suggests that combining multiple metabolic factors into one score provides more useful information than any single measure on its own.
This research suggests that METS-IR could be a practical and simple tool for clinicians to help identify OSA patients — especially those with severe sleep apnea — who are at higher risk of developing difficult-to-control high blood pressure. Since METS-IR uses routine lab values and body measurements, it could potentially be incorporated into standard care to flag high-risk patients earlier and guide more targeted management strategies.
Xin J, Xie R, Zhou W, Li J, Zhou C, Zhu T. (2026). Association of Metabolic Score for Insulin Resistance With Resistant Hypertension and Hypertension in Obstructive Sleep Apnea.. The clinical respiratory journal. https://doi.org/10.1111/crj.70211