ORIGINAL RESEARCH article
Front. Nutr.
Sec. Clinical Nutrition
This article is part of the Research TopicDietary Inflammation, Metabolic Syndrome, and Cardiometabolic Health: Mechanisms, Inflammaging, and Translational InsightsView all 5 articles
Vitamin D deficiency and Risk of heart failure in patients with Obstructive Sleep Apnea: A Cohort Analysis
Provisionally accepted
- 1Chi Mei Medical Center, Tainan, Taiwan
- 2E-Da Hospital, Yanchao District, Taiwan
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Background: 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. Methods: We conducted a retrospective cohort analysis using data from the TriNetX Global Collaborative Network (2010–2022) to investigate whether vitamin D deficiency, defined as a 25-hydroxyvitamin D concentration <20 ng/mL, is associated with new-onset heart failure in adults diagnosed with OSA. Patients with sufficient vitamin D levels (≥30 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. Results: 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 1.37–1.53; p<0.001), all-cause mortality (HR 1.76; 95% CI 1.64–1.89; p<0.001), secondary pulmonary hypertension (HR 1.25; 95% CI 1.13– 1.38; p<0.001), and pulmonary embolism (HR 1.31; 95% CI 1.17–1.47; p<0.001). No significant association was observed with primary pulmonary hypertension (HR, 1.22; 95% CI 0.84–1.79; p=0.300). Dose-response analysis revealed attenuated associations for vitamin D insufficiency (20–29.9 ng/mL). Subgroup analyses demonstrated a stronger association among obese patients (p for interaction=0.028). Conclusion: 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–response pattern. These findings suggest that vitamin D status may represent an important factor in cardiovascular risk stratification in patients with OSA.
Keywords: cardiovascular disease, Heart Failure, Mortality, obstructive sleep apnea, Propensity score matching, Vitamin D Deficiency
Received: 27 Nov 2025; Accepted: 31 Jan 2026.
Copyright: © 2026 Chang, Weng, Hung, Ho, Lai, Wu and Chen. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: I-Wen Chen
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