Vitamin D in obstructive sleep apnea syndrome follow up and treatment: A study of 482 cases

Ayşe Karaoğullarından 1 * , Birgul Tuhanioglu 1, Sanem Okşan Yılmaz 1, Zeynel Abidin Erkan 2
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1 ENT Department, Adana City Training and Research Hospital Yüreğir, Adana, Turkey
2 ENT Department, Private Clinic, Adana, Turkey
* Corresponding Author
J CLIN MED KAZ, Volume 18, Issue 5, pp. 63-69.
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Aim: The aim of the study was to determine the factors associated with Obstructıve Sleep Apnea Syndrome (OSAS) severity and vitamin D  deficiency by examining routine laboratory parameters in patients with OSAS without comorbidities. We also aimed to see whether the severity of OSAS increased with decreasing levels of vitamin D.
Material and Method: Patients who presented to Adana City Training and Research Hospital, Ear Nose Throat Clinic with the symptoms of snoring and sleep apnea and who underwent PSG in the sleep laboratory of the Otorhinolaryngology Clinic were included in the study.  Blood results were analyzed retrospectively from the hospital information system. The patients were divided into groups according to their Apnea hypopnea Index (AHI)  values ​​as simple snoring, mild OSAS, moderate OSAS, and severe OSAS. According to the vitamin D values, the patients; Cathogarized as sufficient> 30 ng / ml, insufficient 20-30 ng / ml and deficient <20 ng / ml.
Results: Out of the 777 patients examined 482 patients  fulfilling the inclusion criteria were analysed for the study. It was seen that severity of OSAS increased concomitantly with decreasing Vitamin D levels.
Conclusion: Vitamin D deficiency is observed in patients with OSAS and is related to the severity of the disease.  We think that vitamin D therapy may be beneficial in reducing the severity of the disease. 


Karaoğullarından A, Tuhanioglu B, Yılmaz SO, Erkan ZA. Vitamin D in obstructive sleep apnea syndrome follow up and treatment: A study of 482 cases. J CLIN MED KAZ. 2021;18(5):63-9.


  • Archontogeorgis K, Nena E, Papanas N, Steiropoulos P. The role of vitamin D in obstructive sleep apnoea syndrome. Breathe (Sheff). 2018 Sep;14(3):206-215. doi: 10.1183/20734735.000618. PMID: 30186518; PMCID: PMC6118887.
  • Archontogeorgis K, Papanas N, Rizos EC, Nena E, Zissimopoulos A, Tsigalou C, et all. Reduced Serum Vitamin D Levels Are Associated with Insulin Resistance in Patients with Obstructive Sleep Apnea Syndrome. Medicina (Kaunas). 2019 May 20;55(5):174. doi: 10.3390/medicina55050174. PMID: 31137600; PMCID: PMC6572623.
  • Çelikhisar H., İlkhan G., Body Mass Index, 25- Hydroxy Vitamin D and Parathormone levels in City Bus Drivers with Obstructive Sleep Apnea Syndrome.Bozak Med J 2020;10(2):10-12
  • Zicari AM, Occasi F, Di Mauro F, Lollobrigida V, Di Fraia M, Savastano V, et all. Mean Platelet Volume, Vitamin D and C Reactive Protein Levels in Normal Weight Children with Primary Snoring and Obstructive Sleep Apnea Syndrome. PLoS One. 2016 Apr 7;11(4):e0152497. doi: 10.1371/journal.pone.0152497. PMID: 27054959; PMCID: PMC4824489.
  • Cassol CM, Martinez D, da Silva FABS, Fischer MK, Lenz MDCS, Bós ÂJG. Is sleep apnea a winter disease?: meteorologic and sleep laboratory evidence collected over 1 decade. Chest. 2012 Dec;142(6):1499-1507. doi: 10.1378/chest.11-0493. PMID: 22700779.
  • Öncel G., Hüseyinoğlu N., Özlece H., Analysis of vitamin D Receptor Polymorphisms in Turkish Patients with Obstructive Sleep Apnea Syndrome Dicle Med J (2019) 46 (4) : 771 – 78
  • Kheirandish-Gozal L, Peris E, Gozal D. Vitamin D levels and obstructive sleep apnoea in children. Sleep Med. 2014 Apr;15(4):459-63. doi: 10.1016/j.sleep.2013.12.009. Epub 2014 Feb 7. PMID: 24684979; PMCID: PMC4247539.
  • Bischoff-Ferrari HA, Dietrich T, Orav EJ, Hu FB, Zhang Y, Karlson EW, et all. Higher 25-hydroxyvitamin D concentrations are associated with better lower-extremity function in both active and inactive persons aged > or =60 y. Am J Clin Nutr. 2004 Sep;80(3):752-8. doi: 10.1093/ajcn/80.3.752. PMID: 15321818.
  • Goswami U, Ensrud KE, Paudel ML, Redline S, Schernhammer ES, Shikany JM, et all. Osteoporotic Fractures in Men Study Research Group. Vitamin D Concentrations and Obstructive Sleep Apnea in a Multicenter Cohort of Older Males. Ann Am Thorac Soc. 2016 May;13(5):712-8. doi: 10.1513/AnnalsATS.201507-440OC. PMID: 26845389; PMCID: PMC5018890.
  • Wang LF, Lee CH, Chien CY, Chen JY, Chiang FY, Tai CF. Serum 25-hydroxyvitamin D levels are lower in chronic rhinosinusitis with nasal polyposis and are correlated with disease severity in Taiwanese patients. Am J Rhinol Allergy. 2013 Nov-Dec;27(6):e162-5. doi: 10.2500/ajra.2013.27.3948. PMID: 24274207.
  • Johnson T, Avery G, Byham-Gray L. Vitamin D and metabolic syndrome. Topics Clin Nutr 2009;24:47–54.
  • Koivula MK, Matinlassi N, Laitinen P, Risteli J. Four automated 25-OH total vitamin D immunoassays and commercial liquid chromatography tandem-mass spectrometry in Finnish population. Clin Lab. 2013;59(3-4):397-405. doi: 10.7754/clin.lab.2012.120527. PMID: 23724631.
  • Kul A., Araz Ö., The Relation between Obstructive Sleep Apnea Syndrome and Vitamin D, Van Medical Journal 27(1):50-55, 2020
  • Karras SN, Anagnostis P, Antonopoulou V, Tsekmekidou X, Koufakis T, Goulis DG, et all. The combined effect of vitamin D and parathyroid hormone concentrations on glucose homeostasis in older patients with prediabetes: A cross-sectional study. Diab Vasc Dis Res. 2018 Mar;15(2):150-153. doi: 10.1177/1479164117738443. Epub 2017 Nov 8. PMID: 29113459.
  • Mousa A, Naderpoor N, Teede H, Scragg R, de Courten B. Vitamin D supplementation for improvement of chronic low-grade inflammation in patients with type 2 diabetes: a systematic review and meta-analysis of randomized controlled trials. Nutr Rev. 2018 May 1;76(5):380-394. doi: 10.1093/nutrit/nux077. PMID: 29490085.
  • Fan Z, Cao B, Long H, Feng L, Li Q, Zhang Y, et all. Independent association of vitamin D and insulin resistance in obstructive sleep apnea. Ann Endocrinol (Paris). 2019 Nov;80(5-6):319-323. doi: 10.1016/j.ando.2019.09.004. Epub 2019 Nov 1. PMID: 31759518.
  • Liguori C, Romigi A, Izzi F, Mercuri NB, Cordella A, Tarquini E, et all. Continuous Positive Airway Pressure Treatment Increases Serum Vitamin D Levels in Male Patients with Obstructive Sleep Apnea. J Clin Sleep Med. 2015 Jun 15;11(6):603-7. doi: 10.5664/jcsm.4766.
  • Salepci B, Caglayan B, Nahid P, Parmaksiz ET, Kiral N, Fidan A, et all. Vitamin D Deficiency in Patients Referred for Evaluation of Obstructive Sleep Apnea. J Clin Sleep Med. 2017 Apr 15;13(4):607-612. doi: 10.5664/jcsm.6554. PMID: 27998376; PMCID: PMC5359338.
  • E. Öğüş , H. Sürer , A. Kılınç , Fidancı V., Yılmaz G., Dindar N., et all., Evaluation of Vitamin D Levels by Months, Sex and Age Ankara Med J,2015, 15(1):1-5, doi:10.17098/amj.8887
  • Arabi A, El Rassi R, El-Hajj Fuleihan G. Hypovitaminosis D in developing countries-prevalence, risk factors and outcomes. Nat Rev Endocrinol. 2010 Oct;6(10):550-61. doi: 10.1038/nrendo.2010.146. PMID: 20852586.
  • Barceló A, Esquinas C, Piérola J, De la Peña M, Sánchez-de-la-Torre M, Montserrat JM, et all. Vitamin D status and parathyroid hormone levels in patients with obstructive sleep apnea. Respiration. 2013;86(4):295-301. doi: 10.1159/000342748. Epub 2012 Nov 15. PMID: 23154407.
  • Lin QC, Chen LD, Yu YH, Liu KX, Gao SY. Obstructive sleep apnea syndrome is associated with metabolic syndrome and inflammation. Eur Arch Otorhinolaryngol. 2014 Apr;271(4):825-31. doi: 10.1007/s00405-013-2669-8. Epub 2013 Aug 31. PMID: 23995706.
  • Persson LJ, Aanerud M, Hiemstra PS, Hardie JA, Bakke PS, Eagan TM. Chronic obstructive pulmonary disease is associated with low levels of vitamin D. PLoS One. 2012;7(6):e38934. doi: 10.1371/journal.pone.0038934. Epub 2012 Jun 21. PMID: 22737223; PMCID: PMC3380863.
  • McCarty DE, Chesson AL Jr, Jain SK, Marino AA. The link between vitamin D metabolism and sleep medicine. Sleep Med Rev. 2014 Aug;18(4):311-9. doi: 10.1016/j.smrv.2013.07.001. Epub 2013 Sep 26. PMID: 24075129.
  • Johns MW. Reliability and factor analysis of the Epworth Sleepiness Scale. Sleep. 1992 Aug;15(4):376-81. doi: 10.1093/sleep/15.4.376. PMID: 1519015.
  • Abbas A., Samah M. Serum vitamin D level is associated with obstructive sleep apnea state and severity The Egyptian Journal of Chest Diseases and Tuberculosis 2020, 69:256–258 DOI:10.4103/ejcdt.ejcdt_207_18
  • Garcion E, Wion-Barbot N, Montero-Menei CN, Berger F, Wion D. New clues about vitamin D functions in the nervous system. Trends Endocrinol Metab. 2002 Apr;13(3):100-5. doi: 10.1016/s1043-2760(01)00547-1. PMID: 11893522.
  • Saper CB, Scammell TE, Lu J. Hypothalamic regulation of sleep and circadian rhythms. Nature 2005 Oct 27;437(7063):1257-63. doi: 10.1038/nature04284.
  • Piovezan RD, Hirotsu C, Feres MC, Cintra FD, Andersen ML, Tufik S, et all. Obstructive sleep apnea and objective short sleep duration are independently associated with the risk of serum vitamin D deficiency. PLoS One. 2017 Jul 7;12(7):e0180901. doi: 10.1371/journal.pone.0180901. PMID: 28686746; PMCID: PMC5501615.
  • Barceló A, Esquinas C, Piérola J, De la Peña M, Sánchez-de-la-Torre M, Montserrat JM, et all. Vitamin D status and parathyroid hormone levels in patients with obstructive sleep apnea. Respiration. 2013;86(4):295-301. doi: 10.1159/000342748. Epub 2012 Nov 15. PMID: 23154407.
  • Toujani S, Kaabachi W, Mjid M, Hamzaoui K, Cherif J, Beji M. Vitamin D deficiency and interleukin-17 relationship in severe obstructive sleep apnea-hypopnea syndrome. Ann Thorac Med. 2017 Apr-Jun;12(2):107-113. doi: 10.4103/atm.ATM_301_16. PMID: 28469721; PMCID: PMC5399684
  • Chambers ES, Hawrylowicz CM. The impact of vitamin D on regulatory T cells. Curr Allergy Asthma Rep. 2011 Feb;11(1):29-36. doi: 10.1007/s11882-010-0161-8. PMID: 21104171.
  • Redline S, Tishler PV, Schluchter M, Aylor J, Clark K, Graham G. Risk factors for sleep-disordered breathing in children. Associations with obesity, race, and respiratory problems. Am J Respir Crit Care Med. 1999 May;159(5 Pt 1):1527-32. doi: 10.1164/ajrccm.159.5.9809079. PMID: 10228121.
  • Einhorn D, Stewart DA, Erman MK, Gordon N, Philis-Tsimikas A, Casal E. Prevalence of sleep apnea in a population of adults with type 2 diabetes mellitus. Endocr Pract. 2007 Jul-Aug;13(4):355-62. doi: 10.4158/EP.13.4.355. PMID: 17669711.
  • Nagayoshi M, Punjabi NM, Selvin E, Pankow JS, Shahar E, Iso H, et all. Obstructive sleep apnea and incident type 2 diabetes. Sleep Med. 2016 Sep;25:156-161. doi: 10.1016/j.sleep.2016.05.009. Epub 2016 Sep 29. PMID: 27810258; PMCID: PMC5102826.
  • Aronsohn RS, Whitmore H, Van Cauter E, Tasali E. Impact of untreated obstructive sleep apnea on glucose control in type 2 diabetes. Am J Respir Crit Care Med. 2010 Mar 1;181(5):507-13. doi: 10.1164/rccm.200909-1423OC. Epub 2009 Dec 17. PMID: 20019340; PMCID: PMC2830401.
  • Ma D, Zheng X, Dong L, Zheng C, Chen Y, Chen Z, et all. The Relationship of Serum 25-Hydroxyvitamin-D Level with Severity of Obstructive Sleep Apnea in Patients with Type 2 Diabetes Mellitus. Diabetes Metab Syndr Obes. 2020 Apr 28;13:1391-1398. doi: 10.2147/DMSO.S250694. PMID: 32440175; PMCID: PMC7211054.
  • Upala S, Sanguankeo A. Association between 25-Hydroxyvitamin D and Obstructive Sleep Apnea: A Systematic Review and Meta-Analysis. J Clin Sleep Med. 2015 Nov 15;11(11):1347. doi: 10.5664/jcsm.5208. PMID: 26235155; PMCID: PMC4623137.