{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,28]],"date-time":"2026-01-28T18:41:33Z","timestamp":1769625693227,"version":"3.49.0"},"reference-count":81,"publisher":"MDPI AG","issue":"3","license":[{"start":{"date-parts":[[2026,1,26]],"date-time":"2026-01-26T00:00:00Z","timestamp":1769385600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"National Science and Technology Council, Taiwan","award":["111-2314-B-182-019-MY2"],"award-info":[{"award-number":["111-2314-B-182-019-MY2"]}]},{"name":"National Science and Technology Council, Taiwan","award":["113-2314-B-182-072"],"award-info":[{"award-number":["113-2314-B-182-072"]}]},{"DOI":"10.13039\/501100004606","name":"Chang Gung Medical Foundation, Taiwan","doi-asserted-by":"crossref","award":["CMRPG3L0811-2"],"award-info":[{"award-number":["CMRPG3L0811-2"]}],"id":[{"id":"10.13039\/501100004606","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Nutrients"],"abstract":"<jats:p>Background\/Objectives: Obstructive sleep apnea (OSA) is often accompanied by metabolic syndrome (MetS), forming a high-risk phenotype with elevated cardiometabolic burden. The contribution of lifestyle behaviors\u2014particularly eating mechanics and psychological eating cues\u2014to disease severity remains unclear. This study examined independent associations of dietary behaviors and physical activity (PA) with OSA severity, sleep quality, and metabolic health. Methods: Forty-four OSA patients (mean age 38.3 \u00b1 9.1 years; 89% male) underwent attended polysomnography, dual-energy X-ray absorptiometry, and metabolic profiling. Validated questionnaires assessed dietary behaviors, PA, and sleep quality. Hierarchical logistic regression identified predictors of MetS, severe OSA, and poor sleep quality. Results: The prevalence of MetS was 45%. Compared with those with OSA alone, participants with MetS demonstrated significantly greater central adiposity and more severe nocturnal hypoxemia, despite similar apnea\u2013hypopnea indexes. In multivariable models, MetS was independently associated with higher body mass index (adjusted odds ratio [aOR] = 1.64; p = 0.008) and reward eating (aOR = 3.34; p = 0.041), whereas higher total PA was associated with reduced odds (aOR = 0.96; p = 0.026). Poor subjective sleep quality was significantly associated with younger age (aOR = 0.91; p = 0.037). For severe OSA, slow chewing was associated with significantly reduced odds (aOR = 0.24; p = 0.038), while emotional eating was associated with increased odds (aOR = 2.40; p = 0.048). Conclusions: This hypothesis-generating study identifies a high-risk OSA phenotype marked by metabolic dysfunction and hypoxemia. Eating speed (a proxy for mindful eating), emotional and reward-driven eating, and PA independently shape metabolic and respiratory outcomes. These findings support incorporating behavioral nutrition into multidisciplinary OSA management.<\/jats:p>","DOI":"10.3390\/nu18030409","type":"journal-article","created":{"date-parts":[[2026,1,26]],"date-time":"2026-01-26T15:48:30Z","timestamp":1769442510000},"page":"409","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Associations of Dietary Patterns and Physical Activity with Sleep Quality and Metabolic Health Markers in Patients with Obstructive Sleep Apnea: An Exploratory Pilot Study"],"prefix":"10.3390","volume":"18","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8414-595X","authenticated-orcid":false,"given":"Li-Ang","family":"Lee","sequence":"first","affiliation":[{"name":"Department of Otorhinolaryngology-Head and Neck Surgery, Linkou Main Branch, Chang Gung Memorial Hospital, Taoyuan City 33305, Taiwan"},{"name":"School of Medicine, College of Medicine, Chang Gung University, Taoyuan City 33302, Taiwan"},{"name":"School of Medicine, College of Life Science and Medicine, National Tsing Hua University, Hsinchu City 300044, Taiwan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1681-5410","authenticated-orcid":false,"given":"Yi-Ping","family":"Chao","sequence":"additional","affiliation":[{"name":"Department of Otorhinolaryngology-Head and Neck Surgery, Linkou Main Branch, Chang Gung Memorial Hospital, Taoyuan City 33305, Taiwan"},{"name":"Department of Computer Science and Information Engineering, College of Engineering, Chang Gung University, Taoyuan City 33302, Taiwan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ruei-Shan","family":"Hu","sequence":"additional","affiliation":[{"name":"Department of Otorhinolaryngology-Head and Neck Surgery, Linkou Main Branch, Chang Gung Memorial Hospital, Taoyuan City 33305, Taiwan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5782-8835","authenticated-orcid":false,"given":"Wan-Ni","family":"Lin","sequence":"additional","affiliation":[{"name":"Department of Otorhinolaryngology-Head and Neck Surgery, Linkou Main Branch, Chang Gung Memorial Hospital, Taoyuan City 33305, Taiwan"},{"name":"School of Medicine, College of Medicine, Chang Gung University, Taoyuan City 33302, Taiwan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9016-8098","authenticated-orcid":false,"given":"Hsueh-Yu","family":"Li","sequence":"additional","affiliation":[{"name":"Department of Otorhinolaryngology-Head and Neck Surgery, Linkou Main Branch, Chang Gung Memorial Hospital, Taoyuan City 33305, Taiwan"},{"name":"School of Medicine, College of Medicine, Chang Gung University, Taoyuan City 33302, Taiwan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5466-8995","authenticated-orcid":false,"given":"Li-Pang","family":"Chuang","sequence":"additional","affiliation":[{"name":"School of Medicine, College of Medicine, Chang Gung University, Taoyuan City 33302, Taiwan"},{"name":"Department of Pulmonary and Critical Care Medicine, Linkou Main Branch, Chang Gung Memorial Hospital, Taoyuan City 33305, Taiwan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7394-4016","authenticated-orcid":false,"given":"Hai-Hua","family":"Chuang","sequence":"additional","affiliation":[{"name":"School of Medicine, College of Life Science and Medicine, National Tsing Hua University, Hsinchu City 300044, Taiwan"},{"name":"Department of Community Medicine, Cathay General Hospital, Taipei City 106438, Taiwan"},{"name":"Department of Industrial Engineering and Management, National Taipei University of Technology, Taipei City 10608, Taiwan"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2026,1,26]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1389","DOI":"10.1001\/jama.2020.3514","article-title":"Diagnosis and management of obstructive sleep apnea: A review","volume":"323","author":"Gottlieb","year":"2020","journal-title":"JAMA"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"102006","DOI":"10.1016\/j.smrv.2024.102006","article-title":"The association between obstructive sleep apnea and osteoporosis: A systematic review and meta-analysis","volume":"78","author":"Chan","year":"2024","journal-title":"Sleep Med. 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