Association Between Electronic Cigarette Use and Risk of Obstructive Sleep Apnea Among Korean Adults: A Cross-Sectional Nationwide Population-Based Study

Abstract

Background/Objectives: Obstructive sleep apnea (OSA) is known to be closely associated with obesity, cardiovascular diseases, stroke, and mortality, and is a growing public health concern in South Korea. While conventional cigarette smoking is an established risk factor for OSA, the impact of electronic cigarette use on OSA remains poorly understood. This cross-sectional study aimed to investigate the association between electronic cigarette use and the risk of OSA among Korean adults. Methods: This study utilized data from the 2019–2023 Korea National Health and Nutrition Examination Survey (KNHANES). Smoking behavior was categorized into four groups: electronic cigarette users (dual users of electronic and conventional cigarettes), conventional cigarette smokers, non-smokers, and ex-smokers. The risk of OSA was assessed using the STOP-Bang questionnaire (score ≥ 5), and multivariable logistic regression was used to examine associations between smoking behaviors and OSA risk, with full adjustment for potential confounders. Results: Of the total participants, 3.3% were electronic cigarette users, 15.0% conventional cigarette smokers, 26.6% ex-smokers, and 55.1% non-smokers. Compared to non-smokers, the odds of being at high risk for OSA were significantly elevated among electronic cigarette users (OR = 2.01, 95% CI: 1.21–3.33), conventional cigarette smokers (OR = 1.84, 95% CI: 1.32–2.57), and ex-smokers (OR = 1.70, 95% CI: 1.25–2.30). This association remained significant even when the analysis was restricted to male participants. Conclusions: The significant association between electronic cigarette use and increased OSA risk highlights the need for targeted smoking cessation strategies and public health interventions that address the underestimated harms of vaping.