Age-Specific Differences in Factors Associated with Obstructive Sleep Apnea among Middle-Aged Men: Analysis of the Korea National Health and Nutrition Examination Survey (2021–2023)

Background: Obstructive sleep apnea (OSA) is a prevalent sleep disorder in middle-aged men, yet age-specific risk factors within this population remain unclear. This study compared the prevalence and associated factors of high-risk OSA between men aged <50 years and ≥50 years using national survey data.Methods: This cross-sectional study analyzed 11,761 middle-aged men (aged≥40 years) from the Korea National Health and Nutrition Examination Survey (2021–2023). Weighted multivariable logistic regression was performed to identify associated factors in each age group, adjusting for sociodemographic, health-related, and lifestyle variables.Results: High-risk OSA prevalence was 37.2% in men <50 years and 43.6% in men ≥50 years (P<0.001). In men aged <50 years, abdominal obesity showed the strongest association with high-risk OSA (odds ratio [OR]=6.03, 95% confidence interval [CI]=4.75–7.65), followed by current smoking (OR=5.07, 95% CI=3.79–6.79), past smoking (OR=3.21, 95% CI=2.44–4.22), high-risk drinking (OR=2.04, 95% CI=1.51–2.76), high stress level (OR=1.89, 95% CI=1.02–3.48), moderate stress level (OR=1.55, 95% CI=1.02–2.34), and poor subjective health (OR=1.50, 95% CI=1.07–2.09). In men aged ≥50 years, past smoking was the strongest factor (OR=5.69, 95% CI=4.98–6.49), followed by current smoking (OR=3.88, 95% CI=3.28–4.59), abdominal obesity (OR=2.94, 95% CI=2.61–3.31), poor subjective health (OR=2.09, 95% CI=1.77–2.46), high stress level (OR=1.85, 95% CI=1.30–2.63), high-risk drinking (OR=1.63, 95% CI=1.32–2.00), and married status (OR=1.30, 95% CI=1.14–1.48).Conclusions: Risk factors for high-risk OSA differed between younger and older middle-aged men. Younger men require interventions focused on abdominal obesity management, smoking cessation, and alcohol reduction, while older men need comprehensive approaches addressing smoking, metabolic health, and social support. Age-specific screening and prevention strategies are warranted to reduce the burden of OSA in middle-aged men populations.