Couple-level obstructive sleep apnea risk and muscle health in middle- and older-aged adults

Obstructive sleep apnea (OSA) is a prevalent sleep disorder and has been linked to reduced muscle mass and strength. However, its impact within couples remains poorly understood. This study investigated associations between OSA risk and muscle outcomes at both the individual and couple levels in Korean adults.

We analyzed data from 1,597 heterosexual couples aged ≥ 40 years from the 2022-2023 Korea National Health and Nutrition Examination Survey, including 1,020 couples with handgrip strength data. OSA risk was defined as a STOP-Bang score ≥ 3. Muscle mass and strength were assessed using appendicular skeletal muscle mass (ASM) and handgrip strength, each normalized by BMI. Associations were examined using linear regression and the Actor-Partner Interdependence Model, adjusting for sociodemographic, lifestyle, and health-related covariates.

Higher STOP-Bang scores were independently associated with lower ASM/BMI and HGS/BMI in both husbands and wives (all p < 0.001). Partner effects were significant for husbands but not wives. At the couple level, having only one partner at high OSA risk was linked to lower muscle outcomes in that individual, while both partners at high risk exhibited the greatest declines in both outcomes (all p < 0.001).

High OSA risk is associated with reduced muscle mass and strength in both genders, with additive adverse effects observed when both partners are affected. These findings underscore the need to incorporate sleep-related risk factors into musculoskeletal health assessment and highlight the potential value of couple-based approaches for OSA screening and intervention in clinical sleep medicine.