Oral Health-Related Functional Factors Associated with Different Levels of Obstructive Sleep Apnea Risk in Korean Adults: Analysis of a National Survey

Background: This study aimed to investigate the association between oral health-related functional and symptomatic factors and risk of obstructive sleep apnea (OSA) among Korean adults aged 40 years, with a focus on identifying oral health indicators associated with different levels of OSA risk.Methods: Data from the Eighth Korea National Health and Nutrition Examination Survey (20192021) were analyzed.Among 22,559 participants, 8,603 adults aged 40 years with complete data were included.OSA risk was assessed using a modified STOP-B28 questionnaire (Snoring, Tiredness, Observed apnea, high blood Pressure, and body mass index 28 kg/m 2 ).Participants were categorized into normal, low-risk, and high-risk OSA groups, enabling a risk-stratified analysis.Associations between OSA risk levels and multiple oral health-related factors reflecting oral function and symptom history were examined using complex sample cross-tabulation and multivariable logistic regression analyses.Results: Male sex was associated with a higher likelihood of belonging to the low-risk (odds ratio [OR]=1.244)and high-risk (OR=1.587)OSA groups than the normal group (p0.05).Several oral health-related factors showed graded associations with increasing OSA risk.Individuals with masticatory discomfort had 1.349-fold and 1.595-fold higher odds of belonging to the low-risk and high-risk groups, respectively (p0.05).In the high-risk group, moderate speaking discomfort (OR=1.482)and a history of toothache within the past year (OR=1.487)were independently associated with an elevated OSA risk (p0.05).Conclusion: Oral health-related functional discomfort and symptom history were significantly associated with increasing OSA risk levels among middle-aged and older adults.By adopting a risk-based, stratified approach rather than focusing on diagnosed OSA or single oral symptoms, this study revealed that oral health indicators may serve as accessible markers for identifying individuals at elevated risk of OSA, underscoring the potential role of dental and oral healthcare settings in early screening and prevention.