Association between perfluoroalkyl and polyfluoroalkyl substances and risk of obstructive sleep apnea.
OBJECTIVE Epidemiological and toxicological studies have associated perfluoroalkyl and polyfluoroalkyl substances (PFAS) with adverse effects on multiple organ systems. However, the potential link between PFAS exposure and obstructive sleep apnea (OSA) remains limited. METHODS 2,960 participants were selected from two cycles of National Health and Nutrition Examination Survey. OSA was evaluated by the multivariable apnea prediction index, and serum concentrations of nine PFAS were detected. Weighted logistic regression, RCS, and WQS regression were used to assess individual, nonlinear, and mixture associations. RESULTS PFDeA and PFUA showed significant inverse dose-response relationships, with quartile-based analyses showing protective effects for PFDeA, PFHxS, Me-PFOSA-AcOH, PFUA, and n-PFOS. RCS analyses revealed L-shaped nonlinear relationships for PFDeA and PFUA. Sex-stratified analyses identified a female-specific inverse association for Sm-PFOS (P for interaction = 0.025). WQS regression indicated significant protective mixture effects (OR = 0.69, P = 0.007), predominantly driven by PFUA, followed by n-PFOA and PFHxS. CONCLUSION The relationships between PFAS exposure and OSA risk are characterized by compound-specific, concentration-dependent, and sex-dimorphic patterns.