Obstructive sleep apnea risk is associated with poor physical performance: a cross-sectional analysis of the U.S. health and retirement study

STUDY OBJECTIVES: Obstructive sleep apnoea (OSA) may be linked to poor physical performance and fall risk, yet this association remains underexplored. This study examined associations between OSA risk, balance, gait speed and handgrip strength (HGS) in community living adults across age-groups and sexes. METHODS: for females. RESULTS: 6,918 participants (mean age 66 ± 11 years; 57% female) were included. Probable OSA was associated with higher odds of: (i) poor balance in the overall sample (OR:1.23, 95% bootstrapped confidence interval (BCI):1.07-1.39, p = 0.002), 50-64 years (OR: 1.41, BCI: 1.15- 1.72, p < 0.001) and females (OR: 1.30, BCI: 1.10-1.56, p = 0.004); (ii) slow gait speed in the overall sample (OR:1.29, BCI:1.07-1.57, p = 0.007), 80 + years (OR:1.61, BCI:1.07-2.42, p = 0.028) and females (OR:1.39, BCI:1.03-1.91, p = 0.024); and (iii) weak HGS in the overall sample (OR:2.22, BCI:1.90-2.63, p = 0.001), 50-64 years (OR:3.40, BCI: 2.58-4.61, p < 0.001), 65-79 years (OR: 1.93, BCI:1.52- 2.47, p < 0.001), males (OR = 1.87, BCI:1.49-2.35, p < 0.001) and females (OR = 2.67, BCI 2.15-3.33, p < 0.001). CONCLUSIONS: Poor balance, slow gait speed and weak HGS are common among older adults at high risk of OSA. Further research should evaluate causality and assess co-screening to potentially enable early detection of fall risk in older adults. STUDY RATIONALE: OSA is a common but often undiagnosed condition that may contribute to accelerated age-related physical decline and increased fall risk. Despite known links between diagnosed OSA and motor deficits, little is known about how undiagnosed OSA relates to fall-related physical performance measures in large, community-based populations. Study Impact: This study suggests that individuals at high risk of OSA are more likely to have poor balance, slow gait speed, and weak handgrip strength, which are key predictors of fall risk. The observation of these associations in adults as young as 50 years of age warrants future research to evaluate causality and determine if co-screening of OSA and fall risk can help identify those most vulnerable.