This exploratory pilot study identifies a high-risk OSA phenotype marked by metabolic dysfunction and hypoxemia, in which eating speed, emotional and reward-driven eating, and physical activity independently shape metabolic and respiratory outcomes.
The prevalence of metabolic syndrome (MetS) among OSA patients in this sample was 45%.
Participants with MetS demonstrated significantly greater central adiposity and more severe nocturnal hypoxemia compared to those with OSA alone, despite similar apnea-hypopnea indexes.
Higher body mass index was independently associated with increased odds of MetS in multivariable models.
Reward eating was independently associated with significantly increased odds of metabolic syndrome.
Higher total physical activity was associated with reduced odds of metabolic syndrome.
Younger age was significantly associated with poor subjective sleep quality in multivariable models.
Slow chewing was associated with significantly reduced odds of severe OSA.
Emotional eating was independently associated with increased odds of severe OSA.
This research suggests that among people with obstructive sleep apnea (OSA), nearly half also have metabolic syndrome — a cluster of conditions including abdominal obesity, high blood sugar, and abnormal cholesterol levels that together raise the risk of heart disease and diabetes. Interestingly, those who had both conditions showed worse oxygen levels during sleep and more fat around the abdomen compared to those with OSA alone, even though the number of breathing interruptions during sleep was similar between the two groups. This points to a distinct, higher-risk subgroup of OSA patients whose danger lies not just in interrupted breathing but also in how their body processes energy and fat. The study also found that specific eating behaviors and physical activity levels were linked to these health outcomes independently of other factors. People who ate for emotional reasons had higher odds of having severe OSA, while those who ate more slowly — considered a marker of mindful eating — had lower odds of severe OSA. Reward-driven eating (eating for pleasure or as a treat rather than hunger) was linked to higher odds of having metabolic syndrome, while being more physically active was linked to lower odds. Younger patients with OSA reported worse subjective sleep quality than older patients, which may reflect differences in how people perceive or adapt to sleep disruption over time. This research suggests that how and why people eat — not just what they eat — may play a meaningful role in the severity of OSA and related metabolic problems. The findings are preliminary given the small sample size of 44 patients, and the authors describe this as a 'hypothesis-generating' pilot study. Nevertheless, they argue that behavioral approaches to eating, such as mindful eating practices and addressing emotional or reward-based eating, may deserve a place alongside traditional treatments in managing OSA and its metabolic complications.
Lee L, Chao Y, Hu R, Lin W, Li H, Chuang L, et al.. (2026). Associations of Dietary Patterns and Physical Activity with Sleep Quality and Metabolic Health Markers in Patients with Obstructive Sleep Apnea: An Exploratory Pilot Study.. Nutrients. https://doi.org/10.3390/nu18030409