Vitamin D deficiency and risk of heart failure in patients with obstructive sleep apnea: a cohort analysis

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.