Experts estimate that obstructive sleep apnea (OSA), a condition linked to serious health risks like heart disease and diabetes, affects around a billion people worldwide. Central to OSA is obesity, particularly abdominal obesity, and frighteningly, OSA amps up the risk of developing cardiometabolic disease by 300 percent.
Lifestyle modifications, such as a well-rounded, nutritious diet and regular exercise leading to weight loss, are first-line defenses in mitigating the effects of OSA. The authors of a recent study sought to determine if a higher intake of plant-based foods (such as fruits, vegetables, and grains) could influence the likelihood of developing OSA.
According to Registered Dietician Nutritionist Yelena Wheeler, a plant-based diet tends to be relatively high in nutrient-dense foods, many of which contain a ton of anti-inflammatory properties. Anti-inflammatory properties can be protective against OSA, and eating high-fiber foods helps with weight management, lowering the chances of obesity, a contributing factor to OSA, says Wheeler.
While previous studies have honed in on reducing calories and the amounts of specific nutrients, broader dietary patterns, particularly plant-based diets, have been somewhat overlooked. However, food choices, including a higher intake of plant-based foods and fewer animal products, could help manage OSA by keeping inflammation and body fat levels in check.
The Study
The study, featured in ERJ Open Research, looked into various types of plant-based diets to determine if some might be more beneficial than others in reducing OSA risk (1). The researchers analyzed dietary data from 14,210 individuals, categorizing their eating habits into healthy plant-based, unhealthy plant-based, and semi-vegetarian (pro-vegetarian). They then assessed the prevalence of OSA among these groups using a questionnaire.
The categories and scoring went like this:
- Foods were classified into healthy plant foods (like whole grains and fruits), less-healthy plant foods (like refined grains and sweets), and animal foods (like meat and dairy).
- The researchers assigned scores from 1 to 10 based on the consumption of these foods. Higher scores were given for more plant food consumption and less animal food consumption.
- Scores from each food group ranged from 18 (least plant-based) to 180 (most plant-based). These scores were then divided into five tiers to compare varying degrees of plant-based eating, with adjustments made for energy (calorie) intake.
To assess sleep apnea risk, the researchers used the STOP-BANG tool, which evaluates factors such as snoring, fatigue, high blood pressure, BMI, age, neck size (waist size was used as a substitute), and gender. The scores range from 0 to 8, with 0-2 indicating low risk, 3-4 medium risk, and 5+ high risk. High risk is also associated with being male, having a BMI over 35, or having a large waist size.
The study also took into account variables including age, sex, race, smoking status, exercise levels, sleep patterns, alcohol consumption, and the presence of certain health conditions such as heart disease, cancer, or diabetes.
In their analysis, the researchers determined how different plant-based diets could affect the risk of sleep apnea, adjusting for factors such as demographics, lifestyle, and health conditions. They then identified patterns or trends in sleep apnea risk based on diet scores to reveal if and how different diets might affect sleep apnea risk.
What the Results Show
Interestingly, people with a stricter, healthier, plant-based diet are less likely to develop OSA. Conversely, those who eat more unhealthy plant-based foods may increase their risk. Sticking to a diet that’s more nutritious and packed with plant-based foods can likely lower your risk of developing obstructive sleep apnea while indulging in less healthy plant-based choices could potentially increase the risk.
While healthy plant-based, nutrient-dense diets are linked to a reduced risk of chronic diseases and ill health, not all plant-based diets are beneficial — if your version of a plant-based diet includes a lot of refined grains, sugars, and salt, it can do more harm than good.
What This Means for You
Registered dietician Michelle Routhenstein, a Preventive Cardiology Dietitian, Registered Dietitian Nutritionist, and Certified Diabetes Educator specializing in heart disease management and prevention, explains that following a plant-based diet rich in antioxidants with a high plant-based index could potentially reduce the risk of obstructive sleep apnea. This diet can not only address inflammation but also provide a variety of essential nutrients, such as vitamins C and E, which support cardiovascular, metabolic, and respiratory health, she says.
Routhenstein recommends starting with small changes. “Instead of completely overhauling your diet overnight, gradually incorporate more plant-based foods into your meals. For example, you could start by having one vegan meal a day or incorporating more fruits, vegetables, legumes, and whole grains into your diet.”
If you’re a meat-lover and know that giving up meat is not an option, it’s likely a relief to know you don’t have to completely give up steak and burgers to get the benefits outlined in the study. It’s mostly replacing some of the animal food calories with plant-based ones that will have the most significant impact, according to Wheeler. She explains that these foods are highly antioxidant and anti-inflammatory, which ward off sleep apnea.
“Experimenting with different ways of cooking or modifying recipes to include plant-based protein sources is a great way to ease into the diet transition without being overwhelmed or discouraged,” suggests Wheeler. She adds that embracing plant-based snacks and meals by getting creative and discovering new foods is a fun way to adopt a new diet and increase the chances you’ll stick with it.
Beyond sleep apnea protection, transitioning to a nutrient-rich, well-balanced, plant-based diet can enhance heart health, according to Routhenstein. “By incorporating antioxidants, phytochemicals, lean protein, complex carbohydrates, and heart-healthy fats, leading to improvements in cholesterol, blood pressure, and blood sugar levels,” she says.
Wheeler says another benefit of eating your fruits and veggies — a healthier gut microbiome — can positively impact immune system function, sleep quality, and metabolism. Plus, healthy plant-based diets, packed with antioxidant-containing foods, have been shown to prevent certain types of cancers, she says.
“While plant-based diets are getting a lot of attention these days, it really comes down to the quality of your diet,” says Routhenstein. Making these dietary adjustments can help to improve inflammation and optimize cardiometabolic conditions such as OSA, potentially leading to a longer and healthier life.
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Sources
1. Melaku YA, Zhao L, Adams R, et al. Plant-based and vegetarian diets
are associated with reduced obstructive sleep apnoea risk. ERJ Open Res 2024; in press
(https://doi.org/10.1183/23120541.00739-2023).Wheeler, Yelena. Author interview. February 2024.
Routhenstein, Michelle. Author interview. February 2024.
