Sleep apnea risk factors that show up in population studies are male sex, age, body weight, family history, menopause, smoking and alcohol. In the Wisconsin cohort, moderate to severe sleep-disordered breathing was estimated at 17% of men and 9% of women aged 50 to 70, against 10% and 3% at ages 30 to 49. A 10% weight gain predicted a 32% rise in apnea severity. High blood pressure is mostly seen as a consequence of sleep apnea (odds 2.89 at 15 or more events per hour), though a bidirectional link has been proposed. In adults, the evidence for a link with ADHD is mixed. A risk list cannot say whether you have it; a doctor-ordered sleep test can.
Someone in the family has it, you have gained weight, your blood pressure is up, and now you are reading about sleep apnea risk factors at midnight. A list can make you feel better or worse than the facts justify, so it helps to see what the numbers look like. This is an article about odds in groups. It cannot tell you whether you have sleep apnea.
Sleep apnea risk factors, ranked by how much evidence sits behind them
The factors with the strongest support are the ones that have been measured in large groups with overnight sleep studies, not questionnaires. Male sex, age, weight, family history, menopause, smoking and alcohol all have that. Others you will see on lists, like a small jaw or a crowded throat, are anatomical features that sleep doctors do look at. They are left out of the numbers below.
The first thing to see is how much sex and age matter. The Wisconsin Sleep Cohort has followed adults since 1988 and used its data to estimate US prevalence for 2007 to 2010. The estimates for moderate to severe sleep-disordered breathing (15 or more breathing events per hour) are below.
The same group found that these estimates were 14% to 55% higher, depending on the subgroup, than two decades earlier, and ties the update to the obesity epidemic. The earlier, classic 1993 estimate from the same cohort is worth knowing too: sleep-disordered breathing with 5 or more events an hour affected 24% of the men and 9% of the women studied, but only 2% of women and 4% of men met the criteria for sleep apnea syndrome with daytime sleepiness. Male sex and obesity were the strongest associations.
Peppard PE, Young T, Barnet JH, Palta M, Hagen EW, Hla KM. Increased prevalence of sleep-disordered breathing in adults. Am J Epidemiol 2013. PMID 23589584
Young T, Palta M, Dempsey J, Skatrud J, Weber S, Badr S. The occurrence of sleep-disordered breathing among middle-aged adults. N Engl J Med 1993. PMID 8464434
Weight, smoking and alcohol: the risk factors you can change
This is the part of the list with a handle on it. In 690 randomly selected Wisconsin adults who were studied twice, four years apart, a 10% weight gain predicted a 32% increase in the apnea-hypopnea index, and a 10% loss predicted a 26% decrease. A 10% increase in weight went with a six-fold higher chance of developing moderate to severe sleep-disordered breathing. The authors concluded that even modest weight control is likely to help.
Peppard PE, Young T, Palta M, Dempsey J, Skatrud J. Longitudinal study of moderate weight change and sleep-disordered breathing. JAMA 2000. PMID 11122588
Smoking is next. Among 811 adults in the same cohort, current smokers had 4.44 times the odds of moderate or worse sleep-disordered breathing compared with people who had never smoked, and heavy smokers (40 or more cigarettes a day) had much higher odds. Former smokers were not at increased risk after adjustment. Alcohol is the third: a meta-analysis of 13 studies with 279 patients found that it was associated with an average of 3.98 more breathing events per hour, along with more severe snoring and a lower lowest oxygen level in people prone to snoring and apnea.
Wetter DW, Young TB, Bidwell TR, Badr MS, Palta M. Smoking as a risk factor for sleep-disordered breathing. Arch Intern Med 1994. PMID 7944843
Burgos-Sanchez C, Jones NN, Avillion M, Gibson SJ, Patel JA, Neighbors J, Zaghi S, Camacho M. Impact of Alcohol Consumption on Snoring and Sleep Apnea: A Systematic Review and Meta-analysis. Otolaryngol Head Neck Surg 2020. PMID 32513091
These are associations in groups. For an individual they are reasons to take the factor seriously, not a promise that changing it will cure anything. Weight loss for snoring looks at what the weight studies actually measured.
Family history, and why menopause counts for women
Sleep apnea clusters in families. A genetic-epidemiology study measured 561 members of 91 families, with an index person who had laboratory-confirmed sleep apnea or a neighborhood control. In 35% of families two or more members had sleep-disordered breathing. It was found in 21% of the relatives of people with diagnosed sleep apnea and in 12% of the relatives in control families. The study cannot say how much is shared genes, how much shared body shape and how much shared habits, and the authors set out to test how much of the similarity held independent of obesity.
Redline S, Tishler PV, Tosteson TD, Williamson J, Kump K, Browner I, Ferrette V, Krejci P. The familial aggregation of obstructive sleep apnea. Am J Respir Crit Care Med 1995. PMID 7881656
For women, the transition through menopause is a risk factor in its own right. In 589 women in the Wisconsin cohort, postmenopause carried 2.6 times the odds of 5 or more breathing events per hour compared with premenopause, adjusted for age, body habitus and smoking. The numbers and the second study behind them are in What causes snoring in men and women; the symptoms that women describe differently are in Signs of sleep apnea in women.
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. PMID 12615621
Does high blood pressure lead to sleep apnea?
The answer is mostly "the other way around, but it may be a two-way street". The strongest prospective evidence runs from sleep apnea to high blood pressure. In 709 participants followed for four years, the odds of having hypertension at follow-up rose with the breathing-event rate at the start: 1.42 for 0.1 to 4.9 events per hour, 2.03 for 5 to 14.9, and 2.89 for 15 or more, compared with none, after adjusting for body mass index, neck and waist size, age, sex, alcohol and cigarettes.
Peppard PE, Young T, Palta M, Skatrud J. Prospective study of the association between sleep-disordered breathing and hypertension. N Engl J Med 2000. PMID 10805822
The two conditions also overlap heavily in people whose blood pressure is hard to control. In a university hypertension clinic, 41 adults with drug-resistant hypertension (still at or above 140/90 on three or more drugs) each had an overnight study, and 83% had obstructive sleep apnea. It was more common in the men than the women (96% against 65%). Only a randomized trial could show cause and effect, and the authors said as much.
Logan AG, Perlikowski SM, Mente A, Tisler A, Tkacova R, Niroumand M, Leung RS, Bradley TD. High prevalence of unrecognized sleep apnoea in drug-resistant hypertension. J Hypertens 2001. PMID 11725173
On whether high blood pressure itself makes sleep apnea more likely, one review is careful: it calls sleep apnea an important risk factor for hypertension, and says the relationship may be bidirectional, with high blood pressure contributing to a higher risk and severity of sleep apnea. It lists possible mechanisms (upper airway tone, hormone pathways such as aldosterone, fluid shifting toward the neck at night) and says future studies are needed. So if you are asking whether hypertension can cause sleep apnea, the fair reading is: possibly, in part, with the mechanism still being worked out, and with the better evidence for the opposite direction.
Jhamb M, Unruh M. Bidirectional relationship of hypertension with obstructive sleep apnea. Curr Opin Pulm Med 2014. PMID 25203003
Blood pressure that is high or hard to control, together with loud snoring, pauses someone has seen, or heavy sleepiness, is a reason to ask a doctor about a sleep test. Do not change blood pressure treatment on the strength of anything in this article.
Attention problems and sleep apnea: mixed evidence in adults
Sleep apnea and ADHD share symptoms: poor concentration, restlessness, irritability, daytime sleepiness. That overlap is why the connection gets raised. A review of the literature found that attention deficits have been reported in up to 95% of obstructive sleep apnea patients, that 20% to 30% of people with full ADHD were found to have sleep apnea, and that all six interventional studies it located reported improvements in behavior, inattention and overall ADHD after the apnea was treated. The authors concluded that sleep apnea may contribute to ADHD symptoms in a subset of patients, and said controlled trials were needed.
Youssef NA, Ege M, Angly SS, Strauss JL, Marx CE. Is obstructive sleep apnea associated with ADHD? Ann Clin Psychiatry 2011. PMID 21808754
A direct comparison in adults gives a more cautious picture. Researchers compared 81 untreated adults with obstructive sleep apnea with 32 controls. The prevalence of adult ADHD was 7.4% in the apnea group and 6.3% in the controls, which was not a difference. People with both conditions did report more anxiety and daytime sleepiness and worse quality of life. The sample was small and the control group was people with an apnea-hypopnea index above zero, not people without any breathing events, so it is not the last word.
Oğuztürk Ö, Ekici M, Çimen D, Ekici A, Senturk E. Attention deficit/hyperactivity disorder in adults with sleep apnea. J Clin Psychol Med Settings 2013. PMID 23179074
The practical reading: if someone has been treated for ADHD in adulthood and also snores loudly, wakes unrefreshed or has been told they stop breathing, it is reasonable to mention sleep to the prescriber. Case reports describe three adults treated for ADHD who were found to have sleep apnea, but three cases are not evidence of how often that happens.
Naseem S, Chaudhary B, Collop N. Attention deficit hyperactivity disorder in adults and obstructive sleep apnea. Chest 2001. PMID 11157621
Pregnancy, opioids and the rest of the list
Pregnancy raises the odds of sleep-disordered breathing, and it has its own article (Sleep apnea and pregnant women). Some medicines can raise the risk of a different type of breathing pause. Long-term opioid use is the best documented, and the other sleep apnea types are explained in Types of sleep apnea.
One more point, about what is not on the list. Being slim lowers the odds but does not exclude sleep apnea, because the factors add up and none of them is a requirement. That is part of why a negative checklist can mislead, as does sleep apnea without snoring (Can you have sleep apnea without snoring?).
What a list of risk factors cannot tell you
Sleep apnea risk factors describe groups. Having six of them does not mean you have sleep apnea, and having none does not mean you do not. The only way to know is a sleep test ordered by a doctor, either at home with a proper device or in a lab. What you can bring is evidence of your nights: when you snore, whether there are gaps followed by a gasp, how you feel in the morning. How to test for sleep apnea at home describes what is worth gathering and what the real test measures.
SleepTrace listens to your night through the phone's microphone, marks snoring and keeps clips you can play back or show (the free plan plays back 3 clips a month, Premium has no limit). It also shows a breathing screening with a risk level and an average index. That is a screening, not a diagnosis: the app is not a medical device and cannot tell you whether you have sleep apnea or what type. If the picture it gives you matches the list above, take the recording to a doctor, and let them decide what comes next.
One question stays open: whether the ADHD overlap in adults is sleep apnea causing attention problems, the two sharing a cause, or two common conditions meeting by chance. The two adult datasets above point in different directions, and neither settles it.
Frequently asked questions
In population studies the recurring ones are male sex, older age, higher body weight (and weight gained), a family history, menopause in women, smoking and alcohol. In the Wisconsin Sleep Cohort, the share of people with moderate to severe sleep-disordered breathing was estimated at 10% of men and 3% of women aged 30 to 49, and 17% and 9% at ages 50 to 70.
The best-established direction is the reverse: in 709 people followed for four years, those with 15 or more breathing events per hour at the start had 2.89 times the odds of having hypertension at follow-up. A review has proposed that the link may run both ways, with high blood pressure and fluid shifts contributing to sleep apnea, but that part is less established and calls for more studies. Resistant hypertension and sleep apnea very often go together: 83% of 41 patients with drug-resistant hypertension had it.
In adults the evidence is mixed. A review found that attention problems are reported in up to 95% of people with sleep apnea and that all six treatment studies it located reported improved ADHD symptoms afterward. A later study of 81 untreated adults with sleep apnea found adult ADHD in 7.4% of them against 6.3% of controls, no difference.
It clusters. A study of 561 members of 91 families found sleep-disordered breathing in 21% of the relatives of people with diagnosed sleep apnea against 12% among neighborhood control families. Shared weight, anatomy and household habits are all possible parts of that, and the study does not separate them completely.
A risk list can raise your suspicion but cannot confirm anything. Recordings of snoring, pauses and gasping are useful to show a doctor, who can order a sleep test. Sleep apnea cannot be diagnosed from a list or a phone recording.
SleepTrace is a wellness app, not a medical device. This article is general information, not medical advice. If your symptoms are frequent, severe or worrying, please talk to a doctor.
A risk list describes groups, not you. SleepTrace records sound only, saves clips of snoring, marks possible breathing pauses with a time and estimates your sleep phases, so you get a look at your own nights. It is a screening hint, not a diagnosis, and the decision on a sleep study stays with your doctor.
Hear your own night. SleepTrace turns a night of audio into your sleep phases, the sounds you made, and how it all trends. Works without a wearable, better with one. Your phone on the nightstand is enough to start. Get it for iPhone or Android →