Who is at risk for obstructive sleep apnea (OSA)?

Alon Avidan, MD
Obstructive sleep apnea (OSA) risk factors include the following:
  • advanced age
  • obesity
  • sleeping on the back
  • increased size of the tongue
  • increased size of the tonsils and the adenoids in children
Anyone can have obstructive sleep apnea (OSA), but men are twice as likely as women to have it. However, it may be underdiagnosed in women for a number of reasons. Women are less likely than men to report symptoms. Instead, they tend to dismiss their sleepiness or fatigue as a result of their lifestyles,  and those who do report some symptoms suggestive of sleep apnea to a doctor are likely to be misdiagnosed with other conditions like depression or insomnia. Women who are obese or who have been through menopause may be at a higher risk of developing OSA.

Other risk factors include:
  • Older age: People over 40 years of age are more likely to have sleep apnea, but it can affect anyone at any age.
  • Excess weight: Two out of three people with sleep apnea are overweight or obese, but even thin people can have it. Extra fat deposits in the upper airway are thought to predispose to airway obstruction during sleep.
  • Neck circumference: A thick neck is associated with an increased risk of sleep apnea.
  • Narrowed airway: The size of the airways in the nose, throat or mouth may be decreased; for example, there may be physical abnormalities in the nose or upper airway as well as enlarged tonsils or adenoids.
  • Nighttime nasal congestion: Allergic rhinitis, acute upper respiratory tract infection and anatomy have been linked to snoring and OSA.
  • Use of alcohol or sedatives: These relax the muscles in the throat and may promote apneic episodes.
  • Smoking: Smoking can increase inflammation and fluid retention in the upper airway, making apnea worse.
  • Family history: OSA seems to run in some families, suggesting a possible genetic predisposition.
Phil Westbrook
Sleep Medicine

In a sense we are all at risk for obstructive sleep apnea (OSA) because we all have a potentially collapsible upper airway. Also, in all of us, the muscles responsible for holding that airway open as we take in a breath are not as active- are less powerful- during sleep. The balance can be tipped toward collapse by any condition that narrows the upper airway or impairs the activity of the dilating muscles.

You cannot do anything about some risk factors. OA is more than twice as common in men as women, although after menopause this difference between the sexes tends to disappear. You also cannot do anything about getting older, and the prevalence of OSA increases with age, at least up to the age of 65. We do not choose our parents, and studies have shown OSA can run in families. We inherit our facial structure, and small jaws, a high arched palate, and an overbite can make the airway narrow and more collapsible. In children large tonsils that narrow the airway are frequently responsible for OSA.

The culprit in most persons with OSA is something they potentially can do something about- obesity. Over 75% of persons with OSA weigh more than 120% of their ideal body weight. Another way of measuring obesity that takes into account height in called body mass index (BMI). A person with a BMI of over 30 is at increased risk for OSA. Increased neck size is a risk factor. In men a neck size of 18inches or greater (16 inches in women) is associated with an increased risk of OSA.

Habitual snorers, those who snore loudly most nights, are at increased risk. Those who have high blood pressure, especially blood pressure that is difficult to control, are at increased risk, as are those who have had a heart attack or stroke.

A fat middle aged hypertensive sleepy male who snores loudly is the poster child for OSA risk.

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Important: This content reflects information from various individuals and organizations and may offer alternative or opposing points of view. It should not be used for medical advice, diagnosis or treatment. As always, you should consult with your healthcare provider about your specific health needs.