Biopsychosocial Correlates of Suicidal Ideation across Obstructive Sleep Apnea Risk Groups in Korean Adults: A Cross-sectional Secondary Analysis of the 2022~2023 Korea National Health and Nutrition Examination Survey

Purpose: Suicidal ideation is associated with multiple biopsychosocial conditions. Obstructive sleep apnea(OSA) is a common sleep-related condition that coexist with psychological, behavioral, and social factors. However, population-based evidence describing correlates of suicidal ideation across OSA risk groups remains limited. Methods: This cross-sectional secondary analysis used data from the 2022-2023 Korea National Health and Nutrition Examination Survey. OSA risk was classified using the STOP-Bang questionnaire as low (0~2) or high (≥3). Past-year suicidal ideation was self-reported. Multivariable logistic regression analyses accounting for complex sampling design were conducted separately within each OSA risk group. Results: Among 3,447 adults aged ≥40 years, suicidal ideation prevalence was 3.1% in the low-risk group and 4.0% in the high-risk group. Absence of depressive symptoms was associated with lower odds in both groups (high-risk: AOR=0.28, low-risk: AOR=0.11), whereas higher anxiety was associated with higher odds(high-risk: AOR=4.95, low-risk: AOR=5.21). In the high-risk group, current smoking (AOR=3.57) and not sharing meals (AOR=2.97) were additionally associated. In the low-risk group, short sleep duration (AOR=2.41), mental health consultation(AOR=4.20), and older age (AOR=0.26) were observed. Biological indicators were not significant after adjustment. Conclusion: Depression and anxiety were consistently associated with suicidal ideation across OSA risk groups. Additional behavioral, social, and sleep-related factors were observed within specific groups, although these findings reflect descriptive patterns rather than statistically confirmed heterogeneity. Incorporating sleep-related health context may enhance population-level suicide risk assessment and support subgroup identification for targeted screening. Longitudinal studies are needed to clarify temporal relationships and mechanisms.