This large community-based study shows that, irrespective of caloric intake, higher overall dietary quality and an anti-inflammatory diet are inversely associated with sleep apnea. In addition, an overall healthy lifestyle (higher diet quality, higher physical activity level, not smoking, and optimal alcohol consumption) is associated with reduced sleep apnea risk. This association differs by sex, with a stronger association in females. Several sensitivity analyses confirmed the robustness of these findings. This study underlines the potential benefit of improving overall diet quality and health behaviors beyond calorie restriction to support reductions in sleep apnea and the combined effects of OSA and poor diet and lifestyle habits on detrimental health consequences. Further, sex differences highlight that these more holistic lifestyle considerations are particularly important for women with sleep apnea risk, who have largely been overlooked in the sleep apnea literature to date.
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