Sedentary Behaviors Linked to OSA Risk, Greater Risk for Women

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A new study found individuals who are sedentary for > 8 hours a day have a greater risk of obstructive sleep apnea (OSA) than those who are sedentary for < 4 hours a day.¹

“Our study supports that OSA is more common in men, while the results of this study also suggest that the association of sedentary behavior with OSA is more pronounced in women,” wrote investigators, led by Song Cai and SiYu Li from the school of stomatology at Zunyi Medical University in China.

Spending a day just sitting around can cause obesity and lower extremity fluid retention—2 things that can lead to the development of OSA. According to the Sleep Foundation, a 10% weight gain is associated with a 6-fold increase in OSK risk.² Due to the association between OSA and obesity, investigators wanted to explore the link between sedentary behavior and OSA.¹ The sample included 20,115 participants aged ≥ 18 years old with 50.75% females.

The team assessed OSA with 3 questions in the National Health and Nutrition Examination Survey (NHANES) questionnaire. Participants were asked if they had extensive sleepiness during the day 16 – 30 times per month despite sleeping approximately ≥ 7 hours per night on weekdays; if they gasped, snored, or stopped breathing ≥ 3 nights per week; and if they snored ≥ 3 nights per week. If participants responded with “yes” to 1 of the 3 questions, they were considered to have OSA.

To assess sedentary behavior, investigators used a physical activity questionnaire, asking respondents how often on a typical day they spend sitting or reclining. The team characterized sedentary behaviors into 4 levels: < 4 hours per day, 4 – <6 hours per day, 6 – 8 hours a day, and > 8 hours a day. Moreover, investigators assessed the following covariates: age, sex, race/ethnicity (non-Hispanic black, Mexican American, non-Hispanic white, other), education level, marital status, poverty income ratio, body mass index (BMI), smoking status, drinking habits, and sleep duration.

In total, the sample included 20,115 participants aged ≥ 18 years old with 50.75% females. More than half (52.95%) of participants had OSA. Participants were more likely to have OSA if they were male, non-Hispanic White, had a college degree or greater, were married or living with a partner, had obesity, had a diagnosis of hypertension or diabetes, engaged in moderate to vigorous physical activity, slept for 7 – 9 hours a day, and were nonsmokers. Men and women with OSA differed in BMI, history of diabetes, drinking habits, marital status, physical activity, poverty income ratio, race, sleep duration, and smoking habits.

After adjusting for confounders, investigators found participants with > 8 hours a day of sedentary behavior had a greater risk of OSA (odds ratio [HR], 1.22; 95% CI, 1.12 – 1.33; P < .001) compared to < 4 hours a day of sedentary behavior.

Likewise, participants with sedentary behavior 6 – 8 hours a day also had a high risk of OSA (OR, 1.08; 95% CI, 1.00 – 1.16; P = .047)—but not as high as > 8 hours. In contrast, the risk of OSA was not significant for participants who had a sedentary behavior of 4 to < 6 hours (OR, 1.05; 95% CI, 0.97 – 1.13; P = .202)

A stratified analysis showed there was no significant association of sedentary behavior and OSA in men (P > .05). However, for women there was—compared to women with < 4 hours a day of sedentary behavior, participants with ≥ 4 hours a day had an increased risk of OSA (sedentary behavior 4 to < 6 h/d: OR, 1.17; 95% CI, 1.05 – 1.32; P = .005; sedentary behavior 6 to 8 h/d: OR, 1.13; 95% CI, 1.00 – 1.25; P = .054); sedentary behavior for > 8 h/d: OR, 1.35; 95% CI, 1.19 – 1.54; P < .001).

Additionally, an age-stratified analysis showed the link between sedentary behavior and OSA was stronger among older participants. For people aged < 44 years (OR, 1.22; 95% CI, 1.06 – 1.41; P = .006) and 44 to < 60 years (OR, 1.26; 95% CI, 1.07 – 1.49; P = .006), the risk of OSA was higher for participants with sedentary behavior of > 8 hours per day. Additionally, compared to a sedentary behavior of < 4 hours per day, the risk of OSA for participants aged > 60 years was 1.22 times greater for sedentary behavior 4 to < 6 hours per day, 1.16 times greater for sedentary behavior 6 to 8 hours per day, and 1.39 times greater for sedentary behavior > 8 hours per day.

Investigators outlined limitations, including participants self-reporting symptoms of daytime sleepiness, apnea, and snoring so the investigators could diagnose OSA. However, the investigators pointed out this could have left room for bias. Additionally, interpretations of the associations differing by sex remain unclear, and the prevalence of OSA in the study was greater than that of OSA worldwide.

“In conclusion, our study demonstrated a positive association of SB with OSA after adjustment for anthropometric and clinical potential confounders,” investigators wrote. “Because the cross-sectional study could not prove causality, to explore the mechanisms underlying the positive association between SB and OSA, further studies are needed.”

^References

1. ^{Cai S, Li S, Zhou Y, Song J, Peng J. The association between sedentary behavior and obstructive sleep apnea: a cross-sectional study from the NHANES (2007-2008 to 2015-2020). BMC Oral Health. 2024;24(1):224. Published 2024 Feb 12. doi:10.1186/s12903-024-03960-0}
2. ^{Pacheco, D. How Weight Affects Sleep Apnea. Sleep Foundation. January 24, 2024. https://www.sleepfoundation.org/sleep-apnea/weight-loss-and-sleep-apnea. Accessed February 20, 2024.}