Multiple machine-learning-driven metabolic frameworks for long-term prognostic risk assessment in patients with coexisting hypertension and obstructive sleep apnea:insights from a multicenter cohort study

Background: Predictive obesity indices are often based on the body mass index (BMI). Although BMI is widely used, it does not provide a direct measure of obesity. We aimed to utilize multiple machine learning-driven metabolic frameworks to investigate the long-term risk of major adverse cardiovascular and cerebrovascular events (MACCEs) in individuals with hypertension and obstructive sleep apnea (OSA). Methods: This study included 708 patients with hypertension and OSA between January 2017 and December 2021. The measurements of height, weight, neck circumference (NC), waist circumference (WC), neck-circumference-to-height ratio (NHtR), and waist-to-height ratio (WHtR) were collected to calculate the triglyceride-glucose (TyG)-BMI, as well as TyG-NC, TyG-WC, TyG-NHtR, and TyG-WHtR indices. Results: All patients were allocated to the training cohort (n = 446) and independent validation cohort (n = 262). The Boruta plot presented for identifying key predictors is as follows: male sex, age, TyG, TyG-BMI, HbA1c, FPG, triglyceride, creatinine, fibrinogen and AHI. We constructed nine machine learning models-XGBoost, Light Gradient Boosting Machine, Random Forest, Decision Tree, Gradient Boosting, Multi-Layer Perceptron, Support Vector Machine, K-Nearest Neighbors, and Gaussian Naive Bayes-to predict MACCEs. The XGBoost model was selected due to its superior performance evidenced by an AUC of 0.898 (95% CI: 0.822-0.973) and net clinical benefit. SHAP analysis further clarified variable contributions to MACCE risk. Conclusion: This study employed various machine-learning techniques and multidimensional data assessment, allowing for enhanced prediction of metabolic results and supporting the timely detection of high-risk patients with OSA and hypertension in need of focused preventive measures. Clinical Trial Registration: https://www.chictr.org.cn/bin/project/edit?pid=206415, identifier ChiCTR2300075727.