Is Sleep Apnea Genetic?

Sleep apnea has both genetic and environmental risk factors, making it a complex condition rather than a purely inherited one. Genetics can influence traits such as the size and shape of the jaw and upper airway, where the body tends to store fat, and a person’s likelihood of developing obesity. Family members may also share environmental or lifestyle factors that affect sleep apnea risk, which can make it difficult to separate inherited risk from other influences.

Below, we take a closer look at which inherited traits may contribute to this breathing disorder, along with other factors that put a person at risk for a sleep apnea diagnosis. 

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Genetics and Sleep Apnea Risk

There are two types of sleep apnea: obstructive sleep apnea (OSA) and central sleep apnea (CSA). In addition to being the most common type, OSA is much more likely to have a genetic basis. Having a parent, sibling, or child with OSA increases a person’s likelihood of developing OSA by about 50%.

To understand why only OSA runs in families, it’s important to know how the two forms of sleep apnea differ.

Central sleep apnea happens when the brain momentarily stops communicating with the muscles that assist breathing. CSA is often linked to other medical conditions, such as strokes and brain infections, as well as the use of certain narcotic medications.

While there's no current evidence that a person’s genes directly cause CSA, some genetic conditions, such heart failure, can raise a person’s risk for developing CSA.

Genetic Traits That Raise OSA Risk

On the other hand, there are a number of heritable anatomical features that put a person at greater risk for developing obstructive sleep apnea. OSA happens when the upper airway becomes temporarily blocked, either partially or completely, during sleep. Genetic traits that may contribute to this airway blockage include:

• Narrow throat 
• Receded lower jaw
• High arched hard palate
• Unusually long soft palate
• Large or long tongue 
• Obesity, particularly when fat is deposited in the neck, chest, and abdomen

Genes Associated With High OSA Risk

While more research is needed to fully understand the heritability of OSA, studies have associated OSA with polymorphisms—that is, variations in the DNA sequence—in several genes, including:

• Angiopoietin 2 (ANGPT2) 
• Tumor necrosis factor-α (TNFα) 
• Lysophosphatidic acid receptor 1 (LPAR1) in African Americans 
• G protein-coupled receptor 83 (GPR83) in Hispanic Americans 
• β-arrestin 1 (ARRB1) in Hispanic-American Females 
• Hypoxia inducible factor 1 alpha (HIF-1α) in Hispanic Americans 
• Prostaglandin E receptor 3 (PTGER3) in white individuals

These genes fall into a few broad groups: some affect inflammation in the airway, some influence how the body responds to low oxygen, and others shape craniofacial structure. Most of these findings come from individual studies and haven't yet been confirmed across larger populations, so researchers are still working out which variants matter most.

Other Risk Factors for Sleep Apnea

Additional traits with genetic underpinnings, like sex and race, can influence a person’s risk of developing sleep apnea, but there are also many non-genetic risk factors for sleep apnea. To varying degrees, OSA and CSA have been linked to age, lifestyle, health conditions, and environment. While OSA and CSA risk factors overlap, they're not exactly the same.

Obstructive Sleep Apnea in Adults

A number of risk factors can predispose adults to developing OSA.

• Age: OSA is more likely to develop as people grow older, although the risk generally plateaus around age 80. One possible reason is that airway muscles and tissues tend to loosen as people age.
• Race: Black individuals are more likely to develop OSA than white individuals, particularly at younger ages. This may be because people with African ancestry tend to have more soft tissue in their upper airways.
• Sex: OSA is more commonly detected in men than in women. One reason could be that men have more fat located in the neck and tongue, which can cause the airway to narrow or become blocked.
• Postmenopause: After menopause, women are at similar risk for OSA as men, suggesting that high estrogen, high progesterone, or low testosterone may have protective effects against OSA.
• Obesity: Between 60% and 70% of people with OSA also have obesity, which may be caused by genetics, lifestyle, or both. Fat in the abdomen, neck, and mouth can put strain on breathing muscles and cause the airway to narrow. Obesity is also connected to inflammation and metabolic conditions that may increase the risk of OSA.
• Smoking: People who smoke nicotine products are up to three times more likely to develop OSA than past smokers and people who have never smoked. Smoking increases upper airway inflammation and mucus production, both of which may lead to a narrower airway.
• Nasal congestion: The risk of experiencing sleep apnea rises by two-thirds for people with nasal congestion. Some people may experience chronic nasal congestion as a result of air pollution.
• Medical conditions: OSA is associated with heart disease, lung disease, kidney disease, type 2 diabetes, and stroke, among other medical conditions.

Some of these differences may have a genetic basis. For example, research has linked certain gene variants specifically to people of African or Hispanic ancestry, as you can see in the list above. This is an active area of study, and scientists are still untangling which genetic factors explain which population differences.

Central Sleep Apnea in Adults

CSA has fewer risk factors than OSA.

• Age: People ages 65 and older have a greater risk of developing CSA, possibly because of the aging process or the presence of other medical conditions, like heart failure, irregular heart rhythm, or stroke.
• Sex: As with OSA, men are more likely to have CSA than women. This is likely due to a difference in hormone levels.
• Medical conditions: Conditions that affect the brain stem, such as cervical spine injuries, brain infections, and strokes can raise the risk of central sleep apnea. CSA associated with Cheynes-Stokes breathing is common in people with heart failure. Kidney failure and irregular heart rhythm may also be associated with CSA.
• Certain medications: Opioid painkillers can make breathing unstable and irregular, leading to CSA if used long term or at high doses. Other painkillers may also increase the risk of CSA because of their effects on the central nervous system.

Sleep Apnea in Children

Children may develop sleep-disordered breathing for a variety of reasons. Risk factors that can lead to sleep apnea in children often involve the upper airway. Children are more likely to develop OSA if they were born prematurely or if they have particular anatomical traits, medical conditions, or environmental conditions including:

• Skull and facial structures that create a narrow airway
• Enlarged tonsils and adenoids
• Obesity
• Asthma
• Allergies
• Exposure to pollution

Risk factors for CSA in children typically involve the central nervous system and its ability to regulate breathing:

• Brain tumors that affect the brain stem
• Brain malformations that affect the brain stem, such as Chiari malformations
• Medications that reduce central nervous system activity and breathing

How to Lower Your Risk of Sleep Apnea

While you can’t change genetic risk factors, there are several steps you can take to lower your risk of developing sleep apnea or reduce its severity.

• Maintaining a healthy weight is one of the most effective strategies, as excess body fat — especially around the neck and upper airway — can increase airway collapse during sleep.
• Regular physical activity can also improve breathing patterns and overall sleep quality.
• Avoiding alcohol and sedatives before bedtime can help prevent excessive relaxation of the throat muscles.
• Sleeping on your side instead of your back may reduce airway obstruction, particularly for people who experience positional sleep apnea.

When to Talk to Your Doctor

If sleep apnea runs in your family or you notice symptoms such as:

• Loud snoring
• Choking or gasping for air during sleep
• Long pauses in between breaths during sleep
• Morning headaches
• Daytime sleepiness
• Not feeling well-rested after a full night’s sleep
• Mood changes
• Poor concentration

Talking to a healthcare provider and getting tested when needed can help identify sleep apnea before it leads to long-term health complications.

You should also talk with a doctor if you or a child in your care has signs of OSA like bedwetting, hyperactivity, rebelliousness, and learning difficulties. Getting treatment for sleep apnea can prevent health complications down the road.

Written by

Martinique Edwards, Contributing Writer

Martinique writes content focused on sleep health, science, and trends. She graduated from the University of Georgia with a bachelor’s degree in Ecology and master’s degree in Environmental Health and has research experience in environmental microbiology and aquatic science. Martinique loves to view the world through an ecological lens, where everything is interconnected. In her free time, she enjoys outdoor activities such as running and parkour.

Reviewed by

Gerard J. Meskill, MD, FAASM, Medical Reviewer

Dr. Gerard J. Meskill is a neurologist and sleep medicine physician specializing in the diagnosis and treatment of sleep disorders, including narcolepsy, obstructive sleep apnea, and insomnia. He is board-certified in both neurology and sleep medicine and has extensive experience helping patients manage complex sleep conditions and disorders of excessive daytime sleepiness.