If you're a person of Asian, South Asian, Pacific Islander, or Native Hawaiian descent, you could develop severe obstructive sleep apnea (OSA), even at a lower body weight than standard screening guidelines would flag.
That’s the upshot of new research that may explain why some people develop the sleep disorder at lower body weights than others — and why certain patients respond better to weight loss interventions than others, highlighting the importance of individualized treatment for OSA.
Obesity is a risk factor for OSA because excess tissue around the throat and gut can narrow the airway, making it more prone to collapse, thus blocking breathing during sleep.
But excess body weight changes the shape of the throat differently across ethnic groups, found the study, which is one of the largest and most detailed anatomical studies of sleep apnea ever conducted. After looking at MRI scans of 583 patients with OSA, researchers found that in people of European descent, the airway flattened as weight increased — expanding front-to-back while narrowing side-to-side. But in Chinese patients, the pattern was different: Their airways became smaller overall with weight gain, with no front-to-back widening.
This helps explain why people of Asian descent tend to have more severe sleep apnea than do White European people of similar age and BMI.
Previous research shows that South Asian people with severe obesity have 85% prevalence of OSA compared to 66% among White European people with the same BMI. Filipino and Native Hawaiian/Pacific Islander populations show similarly elevated rates.
Why Anatomy Matters
Part of this comes down to bone structure. East Asian American people often have smaller jaws and narrower airways, making it easier for the throat to get blocked during sleep.
Weight-related changes — like tongue enlargement, soft palate thickening, and fat deposits — can compound the problem.
“If you're in a population that has craniofacial restriction, and then you develop obesity … that's a recipe for disaster for sleep apnea,” said Richard Schwab, MD, a leading sleep researcher from the University of Pennsylvania’s Perelman School of Medicine, at a 2025 sleep medicine conference.
What’s especially frustrating: Poor sleep can slow your metabolism, making it even harder to shed pounds.
It also increases cortisol, the stress hormone linked to belly fat storage. And the lack of oxygen during sleep can promote inflammation and put stress on your body, making obesity worse.
Are You Dismissing These Symptoms?
Of the 30 million Americans with sleep apnea, only 6 million are diagnosed, leaving 80% unaware they have it.
Symptoms include:
- Persistent tiredness, brain fog, or falling asleep during the day even after eight hours in bed
- Morning headaches
- Mood swings, depression, difficulty concentrating
- Dry mouth when you wake up
Women tend to be diagnosed years later than men, studies show. The Centers for Disease Control and Prevention (CDC) estimates 50%-75% of adults with sleep apnea symptoms never discuss them with doctors. Untreated sleep apnea increases heart disease risk by 30% and stroke risk by 60%. It’s also been associated with type 2 diabetes and even dementia.
What You Can Do
If you’re in one of the at-risk ethnic groups, don’t dismiss symptoms — even if your BMI isn’t within "obesity" thresholds (30 or more).
If you’re diagnosed with sleep apnea, talk to your doctor about the factors that might be driving the condition. If weight gain is a culprit, even losing 5% of your weight can significantly reduce severity. But if it's more about bone structure, you might need a CPAP (continuous positive airway pressure) machine or oral appliance. Your doctor may also talk to you about surgical options.
Regardless of the cause, sleep apnea treatment can make weight loss easier. Quality sleep makes your metabolism work better, helps regulate hormones that control appetite, and improves energy levels and motivation.
