The association between obstructive sleep apnea (OSA) and subclinical cardiac structural changes remains conflicted. This study aimed to investigate the link between OSA and left ventricular remodeling (LVR) and to explore the mediating roles of body mass index (BMI) and blood pressure.

We retrospectively analyzed 518 patients with OSA. Regression models were used to assess the independent association of OSA with left ventricular hypertrophy (LVH). Mediation analysis was employed to quantify the proportion of the effect mediated by BMI and systolic blood pressure (SBP).

The prevalence of LVH was 12.36 %, and concentric remodeling was the most common geometric pattern (49.42 %). While oxygen desaturation parameters correlated with LVR indicators in univariate analysis, these associations were not independent in multivariate regression. Crucially, mediation analysis revealed that BMI and SBP accounted for 85.2 % and 24.5 % of the association between OSA severity (AHI) and LV mass, respectively.

OSA's impact on left ventricular remodeling is not independent but is predominantly mediated through BMI and, to a lesser extent, systemic blood pressure. Our findings underscore the critical importance of weight management and optimal blood pressure control in the future.