When breathing repeatedly stops during sleep, your brain and body may not get enough oxygen, and your sleep can be disrupted. This is what happens with obstructive sleep apnea (OSA), which causes symptoms like daytime drowsiness, exhaustion, and trouble focusing.

Like many conditions, OSA has several risk factors, and the cause is different for everyone. This article outlines 11 risk factors for sleep apnea — seven that raise the chance of a blocked airway and four that relate to lifestyle or other health conditions. Some risk factors, like genetics or age, can’t be changed. Others, such as smoking or drinking alcohol, are more within your control. Addressing certain risk factors may help you breathe better at night and get more restful sleep.

How Does Obstructive Sleep Apnea Happen?

Obstructive sleep apnea is a sleep disorder that occurs when the muscles around your airway relax during sleep, making the airway narrow or blocked. This blockage prevents enough air from getting through, causing your blood oxygen levels to drop. This triggers your brain to wake you up so you can breathe again. The cycle happens repeatedly — some people have hundreds of breathing events during the night without realizing it.

Common symptoms of OSA include:

• Loud snoring
• Episodes of choking or gasping during sleep
• Night sweats
• Nighttime restlessness
• Mood changes, such as depression, anxiety, or irritability
• Excessive daytime sleepiness or fatigue, which can raise the risk of motor vehicle accidents
• Morning headaches

You might not realize that you’re snoring or gasping for air. Often, a partner or someone you live with may be the first to notice these symptoms.

Risk Factors That Lead to a Blocked Airway

Some OSA risk factors increase your risk of a blocked or narrowed airway. These include both features you’re born with and physical traits that can change over time, such as weight or age.

1. Excess Body Weight

People of any weight can have sleep apnea, but obesity or excess body weight raises the risk. Excess fat around the upper airway can narrow it and make it more likely to collapse when the surrounding muscles relax. Fat in the chest area can also reduce lung capacity and worsen nighttime breathing problems.

Between 60 percent and 90 percent of people with OSA have a body mass index (BMI) of 25 or higher. BMI is calculated using height and weight. A BMI of 25 to 29.9 is considered overweight, and a BMI of 30 or more is classified as obesity. BMI isn’t a perfect measure — it doesn’t always equate with health — but it helps explain patterns seen in people with a higher BMI and OSA.

Your doctor may recommend weight loss as part of sleep apnea treatment. Although it may not cure OSA, losing weight can help improve symptoms.

2. Larger Neck Circumference

According to Mayo Clinic, the risk of sleep apnea increases for men with necks measuring 17 or more inches around and women with necks measuring 16 or more inches. In many cases, extra fat deposits increase neck size.

3. Narrow Airways

You might have a naturally narrow airway because of your unique anatomy. Large tonsils or adenoids, a large tongue, or an underbite can make your upper airway narrower. One feature alone may not cause problems, but together, they can make it more likely for your airway to collapse during sleep.

4. Nasal Congestion

Chronic nasal congestion can raise your risk of OSA. For example, ongoing inflammation from allergic rhinitis increases resistance in the airway, leading to pauses in breathing. If nasal congestion is a factor, doctors may recommend inhaled corticosteroids to reduce inflammation in the sinuses.

5. Genetics and Family History

Some risk factors are inherited. You’re more likely to develop OSA if you have a first-degree relative — a parent or sibling — with sleep apnea. Features such as facial structure are often determined by genes. OSA is also more common in Black, Asian, and Hispanic populations.

6. Male Sex

OSA is more common in men than in women. In the United States, OSA affects 25 percent to 30 percent of men and 9 percent to 17 percent of women, according to StatPearls.

7. Older Age

The risk of OSA goes up as you get older. After age 50, men and women develop OSA at about the same rate. However, OSA can happen at any age — even in children.

Health and Lifestyle Risk Factors for Obstructive Sleep Apnea

Some OSA risk factors are linked to health and lifestyle. These include actions or conditions that cause your muscles to relax more than usual, making airway blockages more likely.

1. Drinking Alcohol

Drinking alcohol is a major OSA risk factor, which your doctor will probably discuss with you during your medical evaluation. Alcohol can cause or worsen OSA by:

• Relaxing airway muscles, which can lead to airway blockages
• Raising your arousal threshold, so OSA-related breathing pauses last longer before you wake up
• Increasing nasal congestion by expanding blood vessels in the nose and sinuses
• Slowing down your central nervous system (including your brain and brainstem), which also slows your breathing

OSA already disrupts sleep, so drinking alcohol can make your sleep even less restful.

2. Smoking

Smoking can increase your risk of sleep apnea or make it worse. Researchers have found a connection between high numbers of cigarettes smoked a day and severe OSA. The link is still being studied, but it’s known that smoking increases inflammation and thickens the airway’s mucous membrane. Nicotine also reduces muscle reflexes that keep the upper airway open, which can contribute to sleep-disordered breathing.

3. Certain Drugs and Medications

Some drugs and medications, especially sedatives and hypnotic drugs, can contribute to sleep apnea or worsen OSA. For example, opioids and certain benzodiazepines relax the muscles in the upper airway, which can collapse and block airflow.

Be sure to let your doctor know which medications you take so they can determine if any may contribute to OSA.

4. Medical Conditions

Certain health conditions are associated with a higher risk of obstructive sleep apnea, including:

• Neurological disorders or spinal injuries
• Endocrine disorders such as type 2 diabetes, hypothyroidism, and polycystic ovary syndrome (PCOS)
• Certain genetic disorders, including Down syndrome and Prader-Willi syndrome

Having any of these conditions doesn’t mean you’ll develop OSA, and the connections aren’t always well understood. Talk with your doctor or healthcare provider if you’re concerned about your OSA risk based on related conditions.

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On MySleepApneaTeam, people share their experiences with sleep apnea, get advice, and find support from others who understand.

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