MFR, SVR and ASVR as promising biomarkers in overweight and obese population with obstructive sleep apnea syndrome: insights from an observational study.
MFR, SVR and ASVR were higher in male OSAS patients among overweight and obese adults and might contribute to early recognizing OSAS patients with less symptoms, especially in primary care settings.
Key Findings
Results
OSAS patients in the overweight/obese cohort were older and had higher frequency of male sex, smoking history, and more comorbidities compared to non-OSAS patients.
A total of 192 overweight or obese patients were enrolled, including 122 OSAS patients and 70 non-OSAS patients.
Data were retrospectively collected from physical examination, Epworth Sleepiness Scale, and demographic information.
Subjects were divided into non-OSAS and OSAS groups based on polysomnography data.
The study design was observational.
Results
MFR, SVR, and ASVR were higher in the OSAS group compared to the non-OSAS group, with the difference being particularly pronounced in male OSAS patients.
MFR is defined as muscle-to-fat ratio; SVR as skeletal muscle mass-to-visceral fat area ratio; ASVR as appendicular skeletal muscle mass-to-visceral fat area ratio.
The elevated indices were especially evident in male OSAS patients.
These differences were observed in a cohort of 192 overweight or obese patients.
Sex modulated the magnitude of the observed differences in these indices between OSAS and non-OSAS groups.
Results
MFR, SVR, and ASVR were not independent risk factors for OSAS in the overweight and obese population.
Logistic regression analysis was conducted to evaluate the relationship between these indices and OSAS.
Despite being elevated in OSAS patients, none of MFR, SVR, or ASVR reached statistical significance as independent predictors in multivariate logistic regression.
Restricted cubic spline analysis was also performed to further evaluate these associations.
The sample included 122 OSAS and 70 non-OSAS patients.
Results
Mediation analysis indicated that MFR, SVR, and ASVR may mediate the relationship between age and OSAS, but this mediation effect was influenced by sex.
Mediation analysis was conducted to evaluate whether these body composition indices serve as mediators in the age-OSAS relationship.
The mediating effect of MFR, SVR, and ASVR on the age-OSAS association was found to be sex-dependent.
The direction and magnitude of mediation differed between males and females.
This suggests a complex interplay between age, sex, body composition, and OSAS risk.
Results
ROC curve analysis showed that MFR, SVR, and ASVR had high sensitivity and specificity for OSAS diagnosis in subjects with fewer symptoms.
Receiver operating characteristic (ROC) curves were drawn to evaluate the diagnostic utility of MFR, SVR, and ASVR for OSAS.
The indices demonstrated high sensitivity and specificity particularly among subjects presenting with less prominent OSAS symptoms.
This suggests potential utility for these indices in primary care settings where polysomnography may not be readily available.
The diagnostic performance was evaluated in the context of the full cohort of 192 overweight or obese patients.
Conclusions
The study proposes that MFR, SVR, and ASVR could contribute to early recognition of OSAS in overweight and obese patients with fewer symptoms, particularly in primary care settings.
The study focused on overweight or obese adults, a population at elevated risk for OSAS.
These novel human body composition indices are derived from body composition measurements and represent muscle-fat relationships.
The role of MFR, SVR, and ASVR in OSAS had been largely unknown prior to this study.
The authors suggest clinical applicability for screening purposes in settings where detailed sleep studies are not available.
What This Means
This research suggests that three measures of body composition — the muscle-to-fat ratio (MFR), skeletal muscle mass-to-visceral fat area ratio (SVR), and appendicular skeletal muscle mass-to-visceral fat area ratio (ASVR) — are elevated in overweight and obese adults who have obstructive sleep apnea syndrome (OSAS), especially in men. The study enrolled 192 overweight or obese patients, 122 of whom had OSAS confirmed by sleep testing, and compared these body composition indices between those with and without OSAS. While OSAS patients tended to be older, more often male, and have more smoking history and other health conditions, the body composition ratios alone were not found to be independent predictors of OSAS when other factors were accounted for.
Interestingly, the study found that these body composition indices may act as a link between aging and the development of OSAS, though this relationship appears to differ between men and women. When the researchers tested how well these indices could identify OSAS in people with milder or fewer symptoms, they found the measures performed well in terms of sensitivity and specificity, suggesting they could be useful screening tools.
This research suggests that measuring muscle-to-fat ratios using body composition analysis could help doctors identify overweight or obese patients who may have OSAS but show fewer obvious symptoms — a group that might otherwise go undiagnosed. This could be particularly valuable in primary care settings where full overnight sleep studies are not easily accessible, potentially enabling earlier diagnosis and treatment of sleep apnea in at-risk individuals.
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Zhou H, Gu W, Zheng J, Zhou J, Chen Z, Chen Y, et al.. (2026). MFR, SVR and ASVR as promising biomarkers in overweight and obese population with obstructive sleep apnea syndrome: insights from an observational study.. Annals of medicine. https://doi.org/10.1080/07853890.2026.2730072