A Healthy Plant-Based Diet Linked to Lower OSA Risk

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After observing for sex differences, plant-based diet indices were associated with lower odds of OSA risk in males than females.

A new study found eating a healthy, plant-based diet full of vegetables, fruit, whole grains, and nuts is linked to a lower obstructive sleep apnea (OSA) risk.1

In contrast, a diet high in refined carbohydrates, high-sugar, and high-salt foods has the opposite effect—putting people at a greater risk of OSA.

“This research doesn’t tell us why diet is important, but it could be that a healthy plant-based diet reduces inflammation and obesity,” said lead investigator Yohannes Adama Melaku, PhD, from the FHMRI Sleep Health at Flinders University in Australia, in a press release.2 “These are key factors in OSA risk. Diets rich in anti-inflammatory components and antioxidants, and low in harmful dietary elements, can influence fat mass, inflammation, and even muscle tone, all of which are relevant to OSA risk.”

Nearly 1 billion worldwide are estimated to have OSA, a sleep-breathing disorder causing dangerous impacts on the body, including increasing the risk of hypertension, stroke, heart disease, and type 2 diabetes.1

Obesity is a risk factor for OSA—and just a 10% weight gain is linked to a 6-fold increase in OSA Risk.3 Exercising or dieting to lose weight is recommended for OSA management. According to the American Thoracic Society, losing only 5 – 10% of body weight can improve or get rid of OSA.4

Previous studies on OSA and diet focused on calorie restriction—not diet quality.1 Thus, investigators conducted a cross-sectional study to assess the association of a plant-based diet with OSA risk. Investigators collected data from the National Health and Nutrition Examination Survey (NHANES) (2005 – 2008 & 2015 – 2018) and included 14,210 participants who provided dietary information using the 24-hour recall method.

Nearly half (49.4%) of the participants were male. The prevalence of snoring was 28.5%; 50.5% had intermediate to severe sleep apnea risk and 25.1% had a high sleep apnea risk. Of the sample, 32.8% had insufficient physical activity, and 20.5% smoked.

The team used the STOP-BANG (Snoring, Tired, Observed (Snort), Pressure (blood pressure), Body Mass Index, Age, Neck, Gender) questionnaire to determine OSA risk, as well as healthy, unhealthy, and pro-vegetarian plant-based dietary indices (PDI) to determine a participant’s diet. Investigators collected dietary data from the US Department of Agriculture’s face-to-face interviews.

Investigators determined the micro and macronutrient contents of the food using the USDA Food and Nutrient Database for Dietary Studies. They viewed healthy plant foods as whole grains, fruits, vegetables, nuts, legumes, tea, and coffee; less-healthy plant foods as refined grains, potatoes, sugar-sweetened beverages, sweets, desserts, and salty food; and animal foods as animal fat, dairy, eggs, fish, and meat.

Covariates accounted for in the study include sociodemographic characteristics such as age, sex, marital status, behavioral factors such as smoking, physical activity, sleep duration, and alcohol consumption, and chronic conditions such as cardiovascular disease, cancer, and diabetes.

Investigators found keeping to a plant-based (odds ratio [OR], 0.81; 95% confidence interval [CI], 0.66 – 1.00), healthy plant-based (OR, 0.83; 95% CI, 0.69 – 1.01), or pro-vegetarian diet (OR, 0.84; 95% CI, 0.68 – 1.05) was not associated with an OSA risk. However, consuming an unhealthy plant-based diet (OR, 1.22; 95% CI, 1.00 – 1.49) was linked to an OSA risk. Compared to the first quintile, participants in the fifth quintile of healthy plant-based diet indices had 17% reduced odds of OSA risk than those in the fifth quintile of unhealthy plant-based diet indices with 22% greater odds of OSA.

Melaku and colleagues observed sex differences in estimates for plant-based diet indices, healthy plant-based diet indices, and unhealthy plant-based dietary indices. No sex difference was found for pro-vegetarian plant-based diet indices.

Females (OR, 0.93; 95% CI, 0.68 – 1.28) had greater odds of having a plant-based diet than males (OR, 0.71; 95% CI, 0.56 – 0.90). Females (OR, 1.42; 95% CI, 1.03 – 1.97) also had greater odds of having an unhealthy plant-based diet than males (OR, 1.13; 95% CI, 0.89 – 1.44). In contrast, males (OR, 0.90; 95% CI, 0.68 – 1.18) had greater odds of having a healthy plant-based diet than females (OR, 0.77; 95% CI, 0.54 – 1.09).

“Overall [plant-based diet indices] is primarily associate[d] with reduced odds of OSA risk in males, not females,” investigators wrote. “This suggests potential sex-specific mechanisms or susceptibilities that warrant further exploration.”

Investigators outlined several limitations, including the cross-sectional design and the reliance on 24-hour recall data for dietary information which might not be representative of an individual’s usual consumption patterns.

“These results highlight the importance of the quality of our diet in managing the risk of OSA,” Melaku said.2 “It's important to note these sex differences because they underscore the need for personalized dietary interventions for people with OSA.”


  1. Melaku, Y, Zhao, L, Adams, R, et al. Plant-Based And Vegetarian Diets Are Associated With Reduced Obstructive Sleep Apnea Risk. ERJ Open Research. 2024; DOI: 10.1183/23120541.00739-2023.
  2. People Who a Eat Healthy, Plant-Based Diet Are Less Likely to Suffer with Dangerous Snoring. EurekAlert! February 20, 2024. Accessed February 26, 2024.
  3. How Weight Affects Sleep Apnea. Sleep Foundation. January 24, 2024. Accessed February 26, 2024.
  4. Weight Loss and Sleep Apnea. American Thoracic Society. chrome-extension://efaidnbmnnnibpcajpcglclefindmkaj/ Accessed February 26, 2024.