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High Risk of OSA Associated With Male Sex, Chronic Metabolic Disease


A study found that a high risk of obstructive sleep apnea (OSA) was associated with men and chronic metabolic disease, especially in patients with diabetes, hypertension, and obesity.

The STOP-BANG questionnaire was able to determine the risk of obstructive sleep apnea (OSA) among a patient cohort, with male participants and patients with chronic metabolic disease more likely to have a higher risk of OSA. Patients who had diabetes, hypertension, and obesity were at an especially high risk, according to a study published in The Korean Journal of Internal Medicine.

The STOP-BANG questionnaire has 4 self-reportable (STOP: snoring, weariness, witnessed apnea, and elevated blood pressure) and 4 demographic (BANG: body mass index [BMI], age, neck circumference, and gender) questions. The study aimed to find the prevalence of high-risk OSA when using this questionnaire and to investigate the clinical features and comorbidities associated with OSA.

Data for this study were taken from the eighth phase of the Korea National Health and Nutrition Examination Survey, gathered from 2019 to 2020, conducted by the Korea Centers for Disease Control and Prevention. Participants were excluded if they were younger than 40 years or did not have information on confounding factors, such as diabetes, hypertension, smoking, drinking, income, or education level.

Participants 40 years and older were asked about risk factors associated with OSA through the STOP-BANG questionnaire using yes and no answers. These included snoring, how often the participant felt tired during the daytime, if anyone had observed the participant stop breathing during their sleep, if they were treated for high blood pressure, if they had a BMI over 30 kg/m2, were older than 50 years, had a neck circumference of over 36.3 cm, and reported their gender.

Participants were determined to have a high risk of OSA if they replied in the affirmative for 5 to 8 items, intermediate risk if they replied in the affirmative for 3 to 4 items, and low risk if they said yes to 0 to 2 items. Socioeconomic status, health-related variables, anthropometric, and biochemical measurements were all included in the analysis.

There were 7650 participants in this study, of which 919 (12.0%) had a high risk of OSA. The participants with high-risk of OSA had more men, a higher BMI, increased rates of smoking, heavy alcohol consumption, abdominal obesity, and a higher proportion of employed responders. The group also had higher fasting plasma glucose, blood pressure, and triglyceride levels, and lower total cholesterol, high-density lipoprotein cholesterol, and estimated glomerular filtration rate (eGFR).

Participants with a high risk of OSA according to the STOP-BANG survey also had a higher comorbidity prevalence, with 67.1% having abdominal obesity; 32.7%, diabetes; 73.3%, hypertension; and 66.1%, obesity, all significantly higher compared with the intermediate- and low-risk groups.

Prevalence of high-risk OSA was highest in participants in their 50s (17.8%) and 60s (15.5%) compared with patients in their 40s (7.2%) in total and male populations. The prevalence of OSA in the female group was highest in participants in their 60s (3.1%) and 50s (2.9%) vs participants in their 40s (0.1%).

Participants with high-risk OSA had higher proportions of comorbidities compared with the low- and intermediate-risk groups, with concurrent diabetes, hypertension, and obesity accounting for a 4-fold higher risk of high-risk OSA compared with participants without comorbidities (42.3% vs 11.1%).

In a multivariable logistic regression analysis, high0-risk OSA was significantly associated with age (odds ratio [OR], 1.01; 95% CI, 1.00-1.02), being male (OR, 13.24; 95% CI, 9.34-18.77), and having a higher education level (OR, 1.93; 95% CI, 1.34-2.77). Comorbidities like diabetes (OR, 1.57; 95% CI, 1.25-1.97), hypertension (OR, 4.81; 95% CI, 3.88-5.97), obesity (OR, 2.02; 95% CI, 1.60-2.56), and abdominal obesity (OR, 1.61; 95% CI, 1.28-2.02) were all associated with a high risk of OSA.

There were some limitations to this study. The participants were not confirmed to have OSA through a polysomnography, and risk stratification was based on the self-reporting questionnaire. The true clinical significance of the data also may have been biased due to only including patients 40 years and older.

The researchers concluded that the prevalence of high-risk OSA was 12.0% in the general Korean population, with men and participants with diabetes, hypertension, and obesity at higher risk for the condition.


Huh G, do Han K, Park YM, et al. Comorbidities associated with high-risk obstructive sleep apnea based on the STOP-BANG questionnaire: a nationwide population-based study. Korean J Intern Med. Published online November 10, 2022. doi:10.3904/kjim.2022.198

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