{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,3]],"date-time":"2026-09-03T15:11:39Z","timestamp":1788448299334,"version":"build-2803163510"},"reference-count":35,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,2,19]],"date-time":"2026-02-19T00:00:00Z","timestamp":1771459200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Nutr."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Obstructive sleep apnea (OSA) is independently associated with increased cardiovascular morbidity, and vitamin D deficiency is highly prevalent in OSA patients. However, whether vitamin D deficiency is associated with an elevated risk of heart failure, specifically within the OSA population, remains unclear.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We conducted a retrospective cohort analysis using data from the TriNetX Global Collaborative Network (2010\u20132022) to investigate whether vitamin D deficiency, defined as a 25-hydroxyvitamin D concentration &amp;lt; 20 ng\/mL, is associated with new-onset heart failure in adults diagnosed with OSA. Patients with sufficient vitamin D levels (\u226530 ng\/mL) served as controls. Propensity score matching (1:1) was performed to balance the baseline characteristics. The primary outcome was incident heart failure; secondary outcomes included all-cause mortality, secondary pulmonary hypertension, primary pulmonary hypertension, and pulmonary embolism at the 5-year follow-up.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      After propensity score matching, 36,497 patients were included in each cohort. Vitamin D deficiency was significantly associated with a higher risk of heart failure (HR 1.45; 95% CI 1.37\u20131.53;\n                      <jats:italic>p<\/jats:italic>\n                      &amp;lt; 0.001), all-cause mortality (HR 1.76; 95% CI 1.64\u20131.89;\n                      <jats:italic>p<\/jats:italic>\n                      &amp;lt; 0.001), secondary pulmonary hypertension (HR 1.25; 95% CI 1.13\u20131.38;\n                      <jats:italic>p<\/jats:italic>\n                      &amp;lt; 0.001), and pulmonary embolism (HR 1.31; 95% CI 1.17\u20131.47;\n                      <jats:italic>p<\/jats:italic>\n                      &amp;lt; 0.001). No significant association was observed with primary pulmonary hypertension (HR 1.22; 95% CI 0.84\u20131.79;\n                      <jats:italic>p<\/jats:italic>\n                      = 0.300). Dose-response analysis revealed attenuated associations for vitamin D insufficiency (20\u201329.9 ng\/mL). Subgroup analyses demonstrated a stronger association among obese patients (\n                      <jats:italic>p<\/jats:italic>\n                      for interaction = 0.028).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Among adults with OSA, vitamin D deficiency was linked to a markedly higher risk of developing heart failure as well as other unfavorable cardiopulmonary events, and this association demonstrated a clear dose\u2013response pattern. These findings suggest that vitamin D status may represent an important factor in cardiovascular risk stratification in patients with OSA.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fnut.2026.1755607","type":"journal-article","created":{"date-parts":[[2026,2,19]],"date-time":"2026-02-19T05:24:09Z","timestamp":1771478649000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":9,"title":["Vitamin D deficiency and risk of heart failure in patients with obstructive sleep apnea: a cohort analysis"],"prefix":"10.3389","volume":"13","author":[{"given":"Ying-Jen","family":"Chang","sequence":"first","affiliation":[{"name":"Department of Anesthesiology, Chi Mei Medical Center","place":["Tainan, Taiwan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hsiu-Lan","family":"Weng","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology, E-Da Hospital, I-Shou University","place":["Kaohsiung, Taiwan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kuo-Chuan","family":"Hung","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology, Chi Mei Medical Center","place":["Tainan, Taiwan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chun-Ning","family":"Ho","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology, Chi Mei Medical Center","place":["Tainan, Taiwan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yi-Chen","family":"Lai","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology, Chi Mei Medical Center","place":["Tainan, Taiwan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jheng-Yan","family":"Wu","sequence":"additional","affiliation":[{"name":"Department of Nutrition, Chi Mei Medical Center","place":["Tainan, Taiwan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"I-Wen","family":"Chen","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology, Chi Mei Medical Center","place":["Liouying, Tainan, Taiwan"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,2,19]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"709","DOI":"10.3390\/ijms23020709","article-title":"Disruption of circadian rhythm genes in obstructive sleep apnea patients-possible mechanisms involved and clinical implication","volume":"23","author":"Gabryelska","year":"2022","journal-title":"Int J Mol Sci"},{"key":"B2","doi-asserted-by":"publisher","first-page":"578","DOI":"10.1097\/MCP.0000000000000623","article-title":"A contemporary review of obstructive sleep apnea","volume":"25","author":"Ralls","year":"2019","journal-title":"Curr Opin Pulm Med."},{"key":"B3","doi-asserted-by":"publisher","first-page":"e56","DOI":"10.1161\/CIR.0000000000000988","article-title":"Obstructive sleep apnea and cardiovascular disease: a scientific statement from the American Heart Association","volume":"144","author":"Yeghiazarians","year":"2021","journal-title":"Circulation."},{"key":"B4","doi-asserted-by":"publisher","first-page":"1088","DOI":"10.3390\/diagnostics15091088","article-title":"The global burden of obstructive sleep apnea","volume":"15","author":"Iannella","year":"2025","journal-title":"Diagnostics."},{"key":"B5","doi-asserted-by":"publisher","first-page":"5100","DOI":"10.1038\/s41467-025-60218-1","article-title":"Global warming may increase the burden of obstructive sleep apnea","volume":"16","author":"Lechat","year":"2025","journal-title":"Nat Commun."},{"key":"B6","doi-asserted-by":"publisher","first-page":"2083","DOI":"10.1007\/s11325-023-02810-7","article-title":"Worldwide prevalence and associated risk factors of obstructive sleep apnea: a meta-analysis and meta-regression","volume":"27","author":"de Araujo Dantas","year":"2023","journal-title":"Sleep Breath."},{"key":"B7","doi-asserted-by":"publisher","first-page":"137","DOI":"10.1007\/s11886-019-1228-3","article-title":"Cardiovascular consequences of obstructive sleep apnea","volume":"21","author":"Dredla","year":"2019","journal-title":"Curr Cardiol Rep."},{"key":"B8","doi-asserted-by":"publisher","first-page":"1208","DOI":"10.1016\/j.jacc.2024.02.059","article-title":"Interactions of obstructive sleep apnea with the pathophysiology of cardiovascular disease, Part 1: JACC State-of-the-Art Review","volume":"84","author":"Javaheri","year":"2024","journal-title":"J Am Coll Cardiol."},{"key":"B9","doi-asserted-by":"publisher","first-page":"234","DOI":"10.1016\/j.artere.2024.07.003","article-title":"la Torre M, Pinilla L, Barb\u00e9 F. 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