Sleep Apnea in Skinny People: Debunking the Myth Around OSA and Weight

When you think about people with sleep apnea, one of the things that might come to mind is the fact they’re obese. Perhaps they’re old men with diabetes and a whole host of other illnesses too. But here’s the kicker: sleep apnea in skinny people, women, young healthy adults, and even pro athletes does happen.

Problems like heart disease and stroke are just some of the things you need to worry about with untreated sleep apnea. That’s why it’s all the more important to get diagnosed and treated early, as well as dispel the common misconceptions about sleep apnea and weight.

In this article, we’ll explore the causes of sleep apnea beyond the boundaries of BMI. We’ll also share a few examples of famous athletes with sleep apnea and why they have this condition. 

First, let’s talk about the exact causes of sleep apnea. A sleep disorder that affects about a hundred million people around the globe, it causes a person to stop and start breathing repeatedly throughout the night. It’s often accompanied by loud snoring, gasping, or choking. 

Why does this happen? It depends on the kind of sleep apnea you have.

Yes, weight plays a huge role as an OSA risk factor. People with a body mass index (BMI) of over 35 are more likely to have this condition, along with a plethora of other health problems. But sleep apnea affects people from all walks of life. So besides weight, there are a number of other factors that can increase your risk.

Mouth and Jaw Anatomy

Take a look in the mirror and observe how your mouth is structured. If the following things¹ describe you, you might be at risk of developing OSA:

• Small mandible: Having a small lower jaw (micrognathia) is a common reason for sleep apnea in young healthy adults and children. In this kind of jaw, there’s not enough room for the tongue, which can fall backward and block the airway.
• Overbite: When your mandible is positioned farther back than your upper jaw (retrognathia), it makes your airways more constricted. 
• Enlarged adenoids and tonsils: When these masses of lymphoid tissue in the back of your mouth enlarge, they can hinder the airflow between your mouth and throat. 
• Low hyoid bone positioning: The hyoid bone is a horseshoe-shaped bone resting between the mandible and Adam’s apple. It isn’t anchored by any other bone, making it the only free-floating bone in your body. The farther it is from the mandibular plane, the higher the risk of upper airway collapse or blockage.²

Neck Circumference

Genetics

Have multiple relatives with OSA? If so, you’re likely to develop this condition too.

Researchers estimated that around 40% of the variations in the apnea-hypopnea index (AHI) can be associated with familial influences.³ Simply put, the likelihood for a person to have a certain AHI level is heavily influenced by genetic factors, which means OSA is hereditary. 

Ethnicity

Compared to Caucasians, OSA is more commonly seen in ethnic groups like Asians, Pacific Islanders, Native Americans, African Americans, and Hispanics.⁴

How is race an OSA risk factor? Some of these ethnicities have certain craniofacial features and genetic factors that make them more susceptible to airway obstructions. Obesity, which causes sleep-disordered breathing, is also more prevalent in some of these ethnic groups.⁵ 

Lifestyle

Drinking, smoking, and using sedatives and hypnotic drugs can contribute to sleep apnea. Find out how to manage sleep apnea symptoms through lifestyle changes. 

Certain Medical Conditions

Pregnant women and people with endocrine, neurological, and cardiovascular disorders (e.g. asthma, diabetes, hypertension) are at higher risk of developing OSA.¹

Age and Gender

As you age, the chances of developing OSA increase. This is especially true for people who are 50 years old and above.⁶ Before hitting that age though, men are about three times more likely to develop OSA than women.⁷ 

We’ve mentioned that BMI is a huge contributor to sleep apnea. Those who are on the heavier side are more at risk. But what if you’re neither overweight nor obese and still have sleep apnea? Apart from the abovementioned risk factors, one culprit behind sleep apnea in young healthy adults could be body fat. 

BMI is simply a rough estimate of your body fat. It doesn’t show your exact body fat percentage and distribution. That means you might have excess body fat around your waist, hips, and more importantly, neck, which can hinder breathing.⁸

Again, there is a solid relation between neck circumference and sleep apnea, which leads us to the next section: athletes, bodybuilders and sleep apnea. 

To further debunk the myth that OSA only affects old and overweight men, let’s take a look at a few athletes with sleep apnea.

Although they’re seen as the fittest of them all, their professions may require them to carry some extra weight. These include American football players, bodybuilders, and wrestlers. These athletes might also have excess fat or muscles around their necks, making it harder for their airways to stay open during sleep. 

1. Reggie White

Nicknamed the “Minister of Defense,” prominent NFL defensive player Reggie White died from a cardiac arrhythmia. He was diagnosed with sleep apnea, which was believed to have played a role in cutting his life short.

His wife, Sara, set up the Reggie White Foundation, which aims to make CPAP equipment accessible to those who need it most. If you have a used CPAP, you can give it a second life by donating it to this non-profit organization. Learn more about where to donate used CPAP machines. 

2. Shaquille O’Neal

NBA legend Shaquille O’Neal has been open about his sleep apnea and how he went through an overnight sleep study. In the video “Shaq Attacks Sleep Apnea,” Harvard sleep specialists discussed his treatment options and showed him how to fit a CPAP mask. 

3. Warren Sapp

After the death of his friend, Reggie White, Hall of Fame NFL defensive tackle Warren Sapp took a home sleep test and found out he had sleep apnea. In 2013, he partnered with Zyppah inventor Dr. Jonathan Greenburg to encourage others to get tested and treated for OSA. 

4. Hunter Labrada

Awarded fourth place at the 2021 Mr. Olympia contest, bodybuilder Hunter Labrada shared his experience dealing with sleep apnea in his “Tuesday Tip” video. He said that his quality of life significantly improved after a few months of using a CPAP machine. He also encouraged viewers to get a sleep study done if they think they have sleep apnea. 

5. Percy Harvin

During practice in 2010, NFL wide receiver Percy Harvin passed out when his heart stopped beating for a short period of time. He was diagnosed with sleep apnea, which triggered not only this scary collapse but also the migraines that had plagued him for years.

From then on, he has been using a CPAP machine, which, according to him, was “a 100% difference.” He also said that since starting CPAP therapy, he has always been waking up “refreshed and ready to go.”⁹

While OSA is often linked with obesity, there’s no denying the prevalence of sleep apnea in young healthy adults. Even prominent athletes who are at the top of their game aren’t immune to this sleep disorder. Because apart from weight, factors such as genetics and neck circumference can increase your likelihood of having this condition. 

If you think you have symptoms of OSA, why not consider taking a home sleep apnea test here on RespShop? We’ll send you the NightOwl, a home sleep test device you can wear on your fingertip. Your results will be automatically sent to a sleep doctor, who will interpret them and issue a sleep report. If the doctor diagnoses you with OSA, they’ll write you a prescription for CPAP therapy so you can get started with treatment right away.

Learn more about how a home sleep apnea test works.

Already been diagnosed with OSA? Explore our collection of CPAP machines, masks, tubing, and other CPAP supplies to prepare you for your CPAP journey. For more information about our home sleep test and anything related to sleep apnea, feel free to get in touch using one of the options below.

1. Slowik, J.M., Sankari, A., Collen, J.F. (2023). Obstructive Sleep Apnea. In StatPearls. StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK459252/ 

2. Jo, J. H., Park, J. W., Jang, J. H., & Chung, J. W. (2022). Hyoid bone position as an indicator of severe obstructive sleep apnea. BMC pulmonary medicine, 22(1), 349. https://doi.org/10.1186/s12890-022-02146-0 

3. Redline, S., & Tishler, P. V. (2000). The genetics of sleep apnea. Sleep medicine reviews, 4(6), 583–602. https://doi.org/10.1053/smrv.2000.0120 

4. Villaneuva, A. T., Buchanan, P. R., Yee, B. J., & Grunstein, R. R. (2005). Ethnicity and obstructive sleep apnoea. Sleep medicine reviews, 9(6), 419–436. https://doi.org/10.1016/j.smrv.2005.04.005

5. Dudley, K. A., & Patel, S. R. (2016). Disparities and genetic risk factors in obstructive sleep apnea. Sleep medicine, 18, 96–102. https://doi.org/10.1016/j.sleep.2015.01.015 

6. Sleep apnea: What it is, causes, symptoms & treatment. Cleveland Clinic. (2022, November 15). Retrieved December 18, 2023, from https://my.clevelandclinic.org/health/diseases/8718-sleep-apnea 

7. Mayo Foundation for Medical Education and Research. (2023, July 14). Obstructive sleep apnea. Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/obstructive-sleep-apnea/symptoms-causes/syc-20352090 

8. Millman, R. P., Carlisle, C. C., McGarvey, S. T., Eveloff, S. E., & Levinson, P. D. (1995). Body fat distribution and sleep apnea severity in women. Chest, 107(2), 362–366. https://doi.org/10.1378/chest.107.2.362                          

9. Associated Press. (2010, September 13). With sleep apnea diagnosis, percy harvin believes his migraine problems are in the past. Fox Sports. Retrieved December 19, 2023, from https://www.foxnews.com/sports/with-sleep-apnea-diagnosis-percy-harvin-believes-his-migraine-problems-are-in-the-past.