Sleep apnea is a common but often overlooked condition that affects healthy breathing during sleep. Many people don’t realize they have it, yet it can quietly raise the risk of heart disease, stroke, high blood pressure, and diabetes. Understanding what increases your risk is the first step in catching sleep apnea early and before it affects your brain, heart, or overall quality of life.

1. Excess Weight or Obesity

Carrying extra body weight is the most significant modifiable risk factor for obstructive sleep apnea (OSA). More than 60% of people with moderate to severe OSA are obese (1).

Extra fat around the upper airway can narrow the space needed for airflow. When lying down, gravity adds pressure to already-tight airways, making them more likely to collapse. Neck size is also a predictor. Neck circumferences over 17 inches in men and 16 inches in women are linked to higher OSA risk (2). 

Every 10% increase in body weight has been linked to a sixfold increase in sleep apnea risk (3). Even a moderate weight loss can improve sleep-disordered breathing and lower apnea-hypopnea index (AHI) scores (4).

Obesity is also associated with lower oxygen saturation during the night (5). This puts additional strain on the cardiovascular system and raises the risk of high blood pressure, stroke, and heart failure in people with OSA.

2. Age and Gender

Research shows that up to 34% of middle-aged men may have some form of sleep apnea, compared to 17% of women in the same age group (6). Moreover, men are two to three times more likely to have sleep apnea than women of the same age (7).

Hormonal and anatomical differences directly influence sleep apnea risk. Testosterone may influence upper airway muscle tone, and men tend to have a bulkier upper airway that’s more prone to collapse during sleep. They also tend to store fat in the neck and trunk areas more relevant to airway obstruction.

Women’s risk rises after menopause due to decreasing estrogen and progesterone, which naturally help keep the airway open. By age 60, men and women have similar rates of OSA.

Aging itself reduces muscle tone in the airway and alters breathing control. This means older adults are more vulnerable, even if they are not overweight.

3. Family History and Genetics

Sleep apnea often runs in families. If a parent has OSA, your risk may nearly double. 

Common inherited traits that increase risk include:

  • A recessed chin or small jaw
  • Enlarged tonsils or tongue
  • Narrow nasal passages or a deviated septum
  • Short or thick neck
  • High-arched palate

Genetics is also important in fat distribution, inflammation, and how your brain regulates breathing during sleep. Twin studies suggest that up to 40% of OSA risk may be tied to heritable factors.

Even at a healthy weight, these structural traits can make airway collapse more likely.

4. Alcohol Use, Sedatives, and Muscle Relaxants

Alcohol and sedating medications reduce the muscle tone that keeps the airway open. This makes the airway more likely to collapse during sleep, especially in people who already have narrow airways.

These substances also weaken the brain’s ability to respond to pauses in breathing, which can make apneas longer and more dangerous. As a result, oxygen levels drop more steeply, placing greater strain on the cardiovascular system and increasing next-day fatigue.

A 2018 meta-analysis found that alcohol increased AHI by an average of nearly four events per hour and reduced the lowest oxygen saturation by 2.7%  (8).

Common sedatives that can worsen sleep apnea include:

  • Benzodiazepines (e.g., lorazepam, diazepam)
  • Opioids
  • Antihistamines
  • Barbiturates
  • Sleep aids containing diphenhydramine

If you notice louder snoring or more daytime fatigue when drinking alcohol or using these medications, they may be contributing.

5. Airway Irritants and Nasal Congestion

Individuals with a history of frequent exposure to tobacco smoke are up to three times more likely to develop sleep apnea. Smoke irritates the airway, causing swelling and congestion that make airflow more difficult at night.

Chronic congestion, from allergies, sinus infections, or structural issues, can force mouth breathing, which can destabilize the airway and increase sleep apnea risk (9, 10).

Any condition that restricts nasal airflow can make oxygen levels drop more easily during sleep.

These 6 Factors Put You at Risk for Sleep Apnea

6. Other Medical Conditions That Raise the Risk

Sleep apnea rarely exists in isolation. It often overlaps with other chronic health conditions, many of which can increase both the risk and severity of OSA.

Here are some of the most common:

  • High Blood Pressure: About 50% of people with high blood pressure have sleep apnea (11). The relationship is bidirectional, OSA can raise blood pressure, and uncontrolled hypertension may indicate undiagnosed sleep apnea.
  • Type 2 Diabetes: Nearly 80% of people with type 2 diabetes also have sleep apnea (12). Sleep-related oxygen dips interfere with glucose metabolism and insulin sensitivity.
  • Heart Disease: OSA increases the risk of arrhythmias, heart attacks, and stroke. Repeated oxygen drops trigger stress hormones that strain the cardiovascular system.
  • Polycystic Ovary Syndrome (PCOS): Women with PCOS are at higher risk due to hormonal imbalances, insulin resistance, and central weight gain.
  • Hypothyroidism: Low thyroid hormone levels may reduce respiratory drive and contribute to upper airway obstruction.
  • Chronic pain disorders: People with fibromyalgia or chronic fatigue syndrome often experience non-restorative sleep and undiagnosed OSA.

If you have any of these conditions and struggle with fatigue or unrefreshing sleep, a sleep apnea evaluation can be important.

Are Your Symptoms Linked to These Risk Factors?

Many people blame symptoms on stress, aging, or a busy schedule. Common warning signs include:

  • Loud, persistent snoring
  • Waking up gasping, choking, or coughing
  • Morning headaches or dry mouth
  • Trouble staying asleep or waking up frequently
  • Daytime sleepiness even after 7 to 8 hours in bed
  • Difficulty focusing or remembering things
  • Mood swings, depression, or anxiety

In moderate or severe cases, breathing may stop dozens of times per hour.

Undiagnosed sleep apnea also raises the risk of getting into car accidents due to drowsy driving. According to the National Highway Traffic Safety Administration, drowsy driving causes at least 90,000 crashes in the U.S. every year, and sleep apnea might be a major contributor (13).

If you match the symptoms and have risk factors, sleep apnea should be ruled out with proper testing. 

What to Do if You Think You’re at Risk

If you suspect sleep apnea, the only way to know for sure is through a sleep study.

There are two main options:

  • Home Sleep Apnea Test (HSAT): A small device monitors your oxygen, breathing, and heart rate while you sleep in your own bed. It’s accurate for many people with moderate to severe symptoms.
  • In-Lab Polysomnography: A more detailed test done overnight in a sleep center. Recommended for those with other sleep issues, serious health conditions, or inconclusive results from home testing.

Once diagnosed, your doctor will tailor treatment to your needs. For many, CPAP therapy is the gold standard. It uses mild air pressure to keep the airway open. Other options may include oral appliances, positional therapy, weight management, or surgical solutions in specific cases.

Left untreated, sleep apnea can get worse over time. Early treatment improves your sleep and protects your heart, brain, and blood pressure. It can also improve insulin sensitivity and reduce symptoms of depression or anxiety caused by poor sleep quality.

Expert Care for Sleep Apnea

The Insomnia and Sleep Institute of Arizona is led by board-certified sleep physicians who handle complex cases daily and provide care trusted by other doctors.

Our team provides:

  • Direct evaluation by sleep physicians
  • Expert review of all testing results
  • Both home and in-lab sleep study options
  • Identification of overlooked sleep disorders
  • Evidence-based treatment plans
  • Physician supervision throughout care

We serve patients across Scottsdale, Gilbert, and Phoenix. So, if you’ve noticed warning signs or match more than one risk factor, it’s time to get answers. Contact us to schedule a consultation.

References

  1. Fattal, D., Hester, S., & Wendt, L. (2022). Body weight and obstructive sleep apnea: a mathematical relationship between body mass index and apnea-hypopnea index in veterans. Journal of Clinical Sleep Medicine, 18(12), 2723–2729. https://doi.org/10.5664/jcsm.10190
  2. Ibrahim, A. S., Almohammed, A. A., Allangawi, M. H., Aleem A. Sattar, H. A., Mobayed, H. S., Panneerselvam, B., & Philipose, M. V. (2007). Predictors of obstructive sleep apnea in snorers. Annals of Saudi Medicine, 27(6), 421–426. https://doi.org/10.5144/0256-4947.2007.421
  3. Romero-Corral, A., Caples, S. M., Lopez-Jimenez, F., & Somers, V. K. (2010). Interactions Between Obesity and Obstructive Sleep Apnea. Chest, 137(3), 711–719. https://doi.org/10.1378/chest.09-0360
  4. Malhotra, A., Heilmann, C. R., Banerjee, K. K., Dunn, J. P., Bunck, M. C., & Bednarik, J. (2024). Weight reduction and the impact on apnea-hypopnea index: A systematic meta-analysis. Sleep Medicine, 121, 26–31. https://doi.org/10.1016/j.sleep.2024.06.014
  5. Peppard, P. E., Ward, N. R., & Morrell, M. J. (2009). The Impact of Obesity on Oxygen Desaturation during Sleep-disordered Breathing. American Journal of Respiratory and Critical Care Medicine, 180(8), 788–793. https://doi.org/10.1164/rccm.200905-0773oc
  6. Yeghiazarians, Y., Jneid, H., Tietjens, J. R., Redline, S., Brown, D. L., El-Sherif, N., Mehra, R., Bozkurt, B., Ndumele, C. E., & Somers, V. K. (2021). Obstructive Sleep Apnea and Cardiovascular Disease: A Scientific Statement From the American Heart Association. Circulation, 144(3). https://doi.org/10.1161/cir.0000000000000988
  7. Lin, C. M., Davidson, T. M., & Ancoli-Israel, S. (2008). Gender differences in obstructive sleep apnea and treatment implications. Sleep Medicine Reviews, 12(6), 481–496. https://doi.org/10.1016/j.smrv.2007.11.003
  8. Burgos-Sanchez, C., Jones, N. N., Avillion, M., Gibson, S. J., Patel, J. A., Neighbors, J., Zaghi, S., & Camacho, M. (2020). Impact of Alcohol Consumption on Snoring and Sleep Apnea: A Systematic Review and Meta-analysis. Otolaryngology–Head and Neck Surgery, 163(6), 1078–1086. https://doi.org/10.1177/0194599820931087
  9. Chirakalwasan N;Ruxrungtham K. (2026). The linkage of allergic rhinitis and obstructive sleep apnea. Asian Pacific Journal of Allergy and Immunology, 32(4). https://pubmed.ncbi.nlm.nih.gov/25543037/
  10. Young, T., Finn, L., & Kim, H. (1997). Nasal obstruction as a risk factor for sleep-disordered breathing. Journal of Allergy and Clinical Immunology, 99(2), S757–S762. https://doi.org/10.1016/s0091-6749(97)70124-6
  11. Kazuki Shiina. (2024). Obstructive sleep apnea -related hypertension: a review of the literature and clinical management strategy. Hypertension Research, 47(11), 3085–3098. https://doi.org/10.1038/s41440-024-01852-y
  12. Sushmita Pamidi, & Esra Tasali. (2012). Obstructive Sleep Apnea and Type 2 Diabetes: Is There a Link? Frontiers in Neurology, 3, 126–126. https://doi.org/10.3389/fneur.2012.00126
  13. NHTSA. (2023). NHTSA. https://www.nhtsa.gov/risky-driving/drowsy-driving

 

Disclaimer: The information provided in this blog post is for educational and informational purposes only and is not intended as a substitute for professional medical advice, diagnosis, or treatment. Always consult with a licensed healthcare provider for recommendations specific to your individual health needs.