National Sleep Foundation

Chapter 3: Sleep-Related Breathing Disorders

Risk Factors

Obstructive Sleep Apnea Syndrome (OSAS) occurs in all age groups and both sexes, but a number of factors increase a person’s risk for OSAS.

  • Demographics: OSAS is more common among men1 and post-menopausal women.2 3 OSAS prevalence increases with age and is more common among those aged 40 and older; it increases significantly after age 60.4
  • Race / ethnicity: Certain racial and ethnic groups appear to be at increased risk of OSA, including African-Americans, Pacific-Islanders, and Hispanics.
  • Weight: Excess body weight is a primary risk factor for OSAS, especially if the distribution of weight centers around the person’s trunk.
  • Body type / Physical features: Certain body types are associated with OSAS, such a small upper airway; large tongue, tonsils, or uvula; recessed chin; small jaw or a large overbite;5 and larger neck sizes (17 inches or greater in men, 16 inches or greater in women).6
  • Genetics: OSAS seems to run in families, suggesting that the condition may have a possible genetic basis.7
  • Lifestyle: Using alcohol or sedatives also contributes to OSAS by relaxing the upper airway breathing muscles.8

For additional risk factors and demographic correlates of OSAS, see Table 3.1 below.

Table 3.1: Demographic correlates and risk factors of OSAS 9

Demographic Correlates

Uncontrollable Risk Factors

Controllable Risk Factors


  • Gender
  • 40-70 years
  • Menopause
  • Race / ethnicity



  • Craniofacial and upper airway abnormalities
  • Genetics



  • Overweight and obesity
  • Large neck girth
  • Sedative and alcohol use
  • Nighttime nasal congestion



  1. Bixler EO, Vgontzas AN, Ten Have T, et al. Effects of age on sleep apnea in men: 1, prevalence and severity. Am J Respir Crit Care Med. 1998;157:144-148.
  2. Young T, Finn L, Austin D, Peterson A. Menopausal status and sleep-disordered breathing in the Wisconsin Sleep Cohort Study. Am J Respir Crit Care Med. 2003;167:1181-1185.
  3. Shahar E, Redline S, Young T, et al. Hormone replacement therapy and sleep-disordered breathing. Am J Respir Crit Care Med. 2003;167:1186-1192.
  4. Bixler EO, Vgontzas AN, Lin HM, et al. Prevalence of sleep disordered breathing in women: effects of gender. Am J Respir Crit Care Med. 2001;163:608-613.
  5. Roedig JJ, Phillips BA, Morford LA, et al., Comparison of BMI, AHI, and apolipoprotein E ε4 (APOE-ε4) alleles among sleep apnea patients with different skeletal classifications. J Clin Sleep Med. 2014 Apr 15;10(4):397-402. doi: 10.5664/jcsm.3614.
  6. Dempsey JA, Skatrud JB, Jacques AJ, et al. Anatomic determinants of sleep-disordered breathing across the spectrum of clinical and nonclinical male subjects. Chest. 2002;122:840-851.
  7. Kadotani H, Kadotani T, Young T, et al. Association between apolipoprotein E epsilon4 and sleep-disordered breathing in adults. JAMA. 2001;285:2888-2890.
  8. Wetter DW, Young TB, Bidwell TR, Badr MS, Palta M. Smoking as a risk factor for sleep-disordered breathing. Arch Intern Med. 1994;154:2219-2224.
  9. Young T, Skatrud J, Peppard PE. Risk factors for obstructive sleep apnea in adults. JAMA. 2004;291:2013-2016.