Following a diet rich in healthy plant-based foods may lower the risk of obstructive sleep apnea.

Eating a plant-based diet focused on lots of vegetables, fruit, whole grains, and nuts may reduce the risk of having obstructive sleep apnea (OSA), according to a study published February 21 in ERJ Open Research.^[1]

 Researchers also found that eating an unhealthy plant-based diet — one that contained high amounts of ultra-processed foods, sugary drinks, and high-sugar and high-salt foods — led to a higher risk for OSA.

Risk factors for obstructive sleep apnea may stem from genetics or behavior, including diet, according to the authors. Previous research has mostly focused on the impact of calorie restriction and weight loss, but there’s a gap in knowledge of how overall dietary patterns affect OSA risk, says lead author Yohannes Melaku, PhD, a senior research fellow at Flinders University in Adelaide, Australia. “Our study highlights the significance of a plant-based diet in potentially reducing the risk of obstructive sleep apnea,” he says.

“I think the most important finding of this study was that people who were adherent to a healthy plant-based diet were least likely to exhibit characteristics indicative of OSA — independent of their sex, age, race, calories consumed, smoking, physical activity, alcohol, and sleep duration,” says Devon A. Dobrosielski, PhD, associate professor of exercise science and kinesiology at Towson University in Maryland who has published research on the effectiveness of diet and exercise for reducing obstructive sleep apnea in older adults. Dr. Dobrosielski was not involved in this research.

39 Million Adults in the U.S. Have Obstructive Sleep Apnea

It’s estimated that about 39 million people in the United States have obstructive sleep apnea, a condition in which the upper airway becomes blocked many times during sleep, reducing or completely stopping breathing.^[2]

Factors that narrow the airway — such as being obese, having large tonsils, or changes in hormone levels — can increase the risk for the condition. Men are 2 to 3 times more likely to have sleep apnea than women.

The most common nighttime symptoms are snoring, breathing that starts and stops, and gasping for air during sleep. People with OSA can also experience daytime sleepiness, dry mouth, headaches, and sexual dysfunction or decreased libido. Having obstructive sleep apnea is associated with an increased risk of high blood pressure, stroke, heart disease, and type 2 diabetes.

A Healthy Diet Includes Whole Grains, Vegetables, Fruits, and Nuts

To examine the connection between diet and obstructive sleep apnea, researchers used data from over 14,000 people who were participating in the U.S. National Health and Nutrition Examination Survey.

Diet information was provided by the subjects, who were asked to report everything they had eaten over the last 24 hours. Using that information, people were placed into one of three categories:

• A healthy plant-based diet, which included whole grains, fruits, vegetables, nuts, legumes, tea, and coffee
• A diet that focused more on food derived from animals, including dairy, eggs, fish, seafood, meat, and animal fat
• An unhealthy plant-based diet that included lots of highly processed foods, refined grains, potatoes, sugar-sweetened drinks, sweets, desserts, and salty foods

Researchers used a questionnaire to determine if someone had OSA by asking about a number of factors, including snoring, tiredness, blood pressure, body mass index, age, gender, and waist circumference.

Eating a Healthy Diet Reduced OSA Risk by Nearly 20 Percent

After analyzing the relationships between OSA symptoms, risk factors, and diet, and controlling for factors such as age, race, income, smoking, physical activity, heart disease, cancer, and diabetes, key findings included:

• People with diets highest in healthy plant-based food were 19 percent less likely to be suffering with OSA, compared with those eating diets lowest in plant-based food. Those eating a largely vegetarian diet were also at a lower risk.
• People eating a diet high in unhealthy plant-based foods had a 22 percent higher risk for OSA compared to those eating the lowest amounts of those foods.
• Diet also seemed to affect women’s risk of OSA more. Compared to men, women had a lower risk of OSA if they followed a healthy plant-based diet — but also had a higher risk compared to men if they ate an unhealthy plant-based diet.

“These results highlight the importance of the quality of our diet in managing the risk of OSA,” says Melaku. Although the study wasn’t designed to uncover why diet may play a role, previous research has shown that inflammation and high fat mass are important factors that are related to OSA, he says.

A Healthy Diet May Reduce Inflammation and Excess Weight

“In our previous work, we demonstrated that a healthy diet, particularly an anti-inflammatory one, decreases OSA risk through reducing inflammation and body mass index. We hypothesize that consuming a plant-based diet, especially a healthy one, may impact these factors, thereby affecting OSA risk,” says Melaku.^[3]

It makes sense that a healthy plant-based diet might lower the risk of OSA because those foods may lower oxidative stress and markers of inflammation, which could improve the neuromuscular control mechanisms that keep the upper airway open. That would make a person less likely to suffer from apneas during the night, says Dobrosielski.

Sex Differences Highlight Need for Personalized Interventions

The fact that diet quality impacts the risk of OSA more for women than men also underscores the need for personalized dietary interventions, according to the authors.

Although the current study didn’t investigate the possible reasons for this difference, Melaku theorizes that differences in physiology and hormones could be contributing factors. “More empirical data is required to ascertain the exact cause of these differences,” he adds.

The differences could be due to the differences in how men and women store fat, says Dobrosielski. “Men tend to store more fat in the neck, trunk, and abdomen, which release pro-inflammatory cytokines associated with OSA and place a large mechanical load on the upper airway,” he says. That means OSA may be more severe in men and perhaps the difference in diet quality is not enough to overcome this burden, says Dobrosielski.

Expert Recommendations for People With OSA or at Risk for OSA

Dobrosielski tells his patients who are overweight or obese — regardless of OSA risk status — to focus on the quality of their diet, not quantity. “In addition to telling them to avoid highly processed carbohydrates, foods with added sugar, and high salt, I also tell them to stay away from trans fats. Other fats are bad only in the context of high sugary foods,” he says.

He also recommends exercise, both aerobic and resistance, to get fit — whether it leads to weight loss or not. Research shows that an exercise program can help decrease daytime sleepiness, increase sleep efficiency, and maximize oxygen consumption in people with OSA — regardless of weight loss.^[4]

Editorial Sources and Fact-Checking

Sources:

1. Melaku YA et al. Plant-Based and Vegetarian Diets Are Associated With Reduced Obstructive Sleep Apnoea Risk. ERJ Open Research. February 21, 2024.
2. Sleep Apnea Statistics and Facts You Should Know. National Council on Aging. October 4, 2023.
3. Melaku YA et al. High-Quality and Anti-Inflammatory Diets and a Healthy Lifestyle Are Associated With Lower Sleep Apnea Risk. Journal of Clinical Sleep Medicine. June 1, 2022.
4. de Andrade FMD et al. The Role of Physical Exercise in Obstructive Sleep Apnea. Jornal Brasileiro de Pneumologia. Nov–Dec 2016.

Resources:

1. Dobrosielski DA et al. Diet and Exercise in the Management of Obstructive Sleep Apnoea and Cardiovascular Disease Risk. European Respiratory Review. June 30, 2017.

Important Notice: This article was also published at www.everydayhealth.com by Becky Upham where all credits are due.