Association of Sugar-Sweetened Beverage Consumption with Observed Sleep Apnea and Perceived Stress among Korean Adults Aged 40 Years and Older: Analysis of KNHANES 2019-2023

Abstract

Epidemiologic evidence on the association between sugar-sweetened beverage (SSB) consumption and sleep-related symptoms or perceived stress remains limited, especially among middle-aged and older adults. This study examined the associations between SSB consumption and observed sleep apnea, snoring, daytime tiredness, and perceived stress among Korean adults aged 40 years and older. Cross-sectional data from the Korea National Health and Nutrition Examination Survey 2019-2023 were analyzed (n = 17,255). SSB consumption was assessed via 24-hour dietary recall and categorized as non-consumers, moderate consumers (Q1-Q3), and high consumers (Q4). Multivariable logistic regression with complex survey design adjustment was used to estimate odds ratios (ORs) and 95% confidence intervals (CIs). Among 17,255 participants (mean age 60.2 years, 57.5% women), 10,169 (58.9%) were SSB consumers. Compared with non-consumers (n = 7,086), the highest intake group (Q4, n = 2,542) showed higher odds of observed sleep apnea (OR 1.32; 95% CI 1.09-1.60) and perceived stress (OR 1.23; 95% CI 1.08-1.40). In sex-stratified analyses, the association with observed sleep apnea was significant among men (OR 1.29; 95% CI 1.04-1.60) but not women (OR 1.22; 95% CI 0.89-1.67), although formal interaction analyses did not support significant effect modification by sex. Higher odds of perceived stress were observed in both men (OR 1.24; 95% CI 1.02-1.50) and women (OR 1.22; 95% CI 1.02-1.45). No significant associations were found for snoring or daytime tiredness. Higher SSB consumption was associated with observed sleep apnea and perceived stress, and prospective studies are needed to clarify temporal relationships and underlying mechanisms.