Sleep efficiency and sleep disturbance were independently associated with high cardiovascular risk in non-obese sleep disordered breathing, with no such relationship found in obese SDB participants.
The majority of community residents with sleep disordered breathing in Guangdong were non-obese.
Obese SDB participants had a significantly higher prevalence of high cardiovascular risk compared to non-obese SDB participants.
Non-obese SDB participants with high cardiovascular risk had higher Pittsburgh Sleep Quality Index (PSQI) scores than those with low cardiovascular risk.
Sleep efficiency was independently associated with high cardiovascular risk in non-obese SDB participants.
Sleep disturbance was independently associated with high cardiovascular risk in non-obese SDB participants.
No relationship was found between PSQI components and cardiovascular risk in obese SDB participants.
This research suggests that among people with sleep disordered breathing (SDB, which includes conditions like sleep apnea) living in the Guangdong community in China, the vast majority—about 92%—were not obese. This is notable because SDB is commonly associated with obesity in clinical settings, but community-based populations may look quite different. The study also found that non-obese people with SDB had a lower overall rate of high cardiovascular risk (about 19%) compared to obese people with SDB (about 28%), but cardiovascular risk was still meaningfully elevated in the non-obese group. For non-obese people with SDB specifically, two aspects of poor sleep quality were linked to higher cardiovascular risk: low sleep efficiency (spending a small proportion of time in bed actually asleep) and frequent sleep disturbances during the night. People with very low sleep efficiency (64% or below) were 152% more likely to be in the high cardiovascular risk category, and those with fairly bad sleep disturbances were 109% more likely to be in the high cardiovascular risk category, compared to those without these problems. Importantly, these relationships were not found in obese SDB participants, suggesting the groups may have different underlying mechanisms connecting sleep and heart health. This research suggests that non-obese individuals with sleep disordered breathing should not be considered low-risk simply because they are not overweight. Poor subjective sleep quality—particularly low sleep efficiency and frequent nighttime disturbances—may be important indicators of cardiovascular risk in this population. The findings point toward non-obese SDB potentially being a distinct clinical phenotype that warrants its own attention and further study, rather than being grouped with the more commonly studied obese SDB population.
Lao M, Shan G, Feng T, Zhou R, Yuan P, Hu Y, et al.. (2026). Sleep efficiency and disturbance is associated with cardiovascular risk in non-obese sleep disordered breathing: The Guangdong sleep health study.. Respiratory medicine. https://doi.org/10.1016/j.rmed.2026.108644