{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T16:41:33Z","timestamp":1787071293131,"version":"build-2736575974"},"reference-count":30,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"130","license":[{"start":{"date-parts":[[2026,1,1]],"date-time":"2026-01-01T00:00:00Z","timestamp":1767225600000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0"}],"content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2026,1]]},"abstract":"\n Objective:<\/jats:bold>\n This study examined the association between obstructive sleep apnea (OSA) risk and hearing difficulty and evaluated whether oral health problems mediate this relationship in a nationally representative Korean population.\n Methods:<\/jats:bold>\n We analyzed 15,163 adults aged \u226540 years from the Korea National Health and Nutrition Examination Survey (KNHANES) 2019\u20132023 datasets. OSA risk was defined using the snoring, tiredness, observed apneas, pressure, body mass index, age, neck circumference, and gender (STOP-BANG) questionnaire (low risk: 0\u20132; high risk: \u22653). Oral health problems were operationalized as the summed score of self-reported chewing difficulty and speaking difficulty (two 5-point items; range 2\u201310). Hearing difficulty was assessed using the KNHANES 4-point self-reported hearing scale (1\u2009=\u2009no difficulty to 4\u2009=\u2009cannot hear at all). Mediation analyses were conducted using complex-sample hierarchical regression with design-weighted estimation, adjusting for survey year, age, sex, education, marital status, income, smoking, alcohol consumption, metabolic\/cardiovascular disease comorbidities, occupational noise exposure, and tinnitus.\n Results:<\/jats:bold>\n Adults with high-OSA risk had higher weighted mean hearing difficulty scores than the low-risk group (1.23 vs. 1.16). In the adjusted model, OSA risk was associated with hearing difficulty [total effect\n \u03b2<\/jats:italic>\n \u2009=\u20090.031, 95% confidence interval (CI): 0.013\u20130.048,\n P<\/jats:italic>\n < 0.001]. Oral problems were associated with OSA risk (\n \u03b2<\/jats:italic>\n \u2009=\u20090.111, 95% CI: 0.049\u20130.174,\n P<\/jats:italic>\n < 0.001) and hearing difficulty (\n \u03b2<\/jats:italic>\n \u2009=\u20090.014, 95% CI: 0.000\u20130.027,\n p\u2009<\/jats:italic>\n =\u20090.047). The indirect effect was statistically significant (\n \u03b2<\/jats:italic>\n \u2009=\u20090.001, 95% CI: 0.001\u20130.002). The direct effect of OSA risk on hearing difficulty remained significant (\n \u03b2<\/jats:italic>\n \u2009=\u20090.019, 95% CI: 0.011\u20130.047,\n P<\/jats:italic>\n < 0.001).\n Conclusions:<\/jats:bold>\n The risk of OSA based on STOP-BANG was associated with increased hearing difficulty among Korean adults, and oral health problems statistically accounted for a small proportion of this cross-sectional association. These results highlight the potential value of jointly considering sleep-related symptoms, oral function, and hearing outcomes in population health research.\n <\/jats:p>","DOI":"10.4103\/nah.nah_211_25","type":"journal-article","created":{"date-parts":[[2026,3,9]],"date-time":"2026-03-09T12:00:14Z","timestamp":1773057614000},"page":"194-204","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":0,"title":["Mediating Role of Oral Problems in the Link between Obstructive Sleep Apnea Risk and Hearing Difficulties: A Cross-sectional Study from the Korea National Health and Nutrition Examination Survey 2019\u20132023"],"prefix":"10.4103","volume":"28","author":[{"given":"Yuanyuan","family":"Xing","sequence":"first","affiliation":[{"name":"Department of Nursing, Baicheng Medical College, Baicheng, Jilin 137000, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yu-Rin","family":"Kim","sequence":"additional","affiliation":[{"name":"Department of Dental Hygiene, Silla University, Sasang-gu, Busan, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Seon-Rye","family":"Kim","sequence":"additional","affiliation":[{"name":"Institute of Health Medical Education Convergence Research, Kangwon National University, Samcheok, Gangwon State 25913, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2026,2,28]]},"reference":[{"key":"R1-20260326","doi-asserted-by":"crossref","first-page":"2083","DOI":"10.1007\/s11325-023-02810-7","article-title":"Worldwide prevalence and associated risk factors of obstructive sleep apnea: a meta-analysis and meta-regression","volume":"27","author":"de Araujo Dantas","year":"2023","journal-title":"Sleep Breath"},{"key":"R2-20260326","doi-asserted-by":"crossref","first-page":"865","DOI":"10.1016\/j.jopan.2023.01.018","article-title":"Global prevalence of obstructive sleep apnea in the elderly and related factors: a systematic review and meta-analysis study","volume":"38","author":"Ghavami","year":"2023","journal-title":"J PeriAnesth Nurs"},{"key":"R3-20260326","doi-asserted-by":"crossref","first-page":"101847","DOI":"10.1016\/j.smrv.2023.101847","article-title":"A review of supine position related obstructive sleep apnea: classification, epidemiology, pathogenesis and treatment","volume":"72","author":"Landry","year":"2023","journal-title":"Sleep Med Rev"},{"key":"R4-20260326","doi-asserted-by":"crossref","first-page":"219","DOI":"10.1007\/s10072-021-05765-3","article-title":"The effect of obstructive sleep apnea on the increased risk of cardiovascular disease: a systematic review and meta-analysis","volume":"43","author":"Salari","year":"2022","journal-title":"Neurol Sci"},{"key":"R5-20260326","doi-asserted-by":"crossref","first-page":"366","DOI":"10.1186\/s12871-022-01912-1","article-title":"Validation of the STOP-BANG questionnaire as a preoperative screening tool for obstructive sleep apnea: a systematic review and meta-analysis","volume":"22","author":"Hwang","year":"2022","journal-title":"BMC Anesthesiol"},{"key":"R6-20260326","first-page":"40","article-title":"Damage of inner ear sensory hair cells via mitochondrial loss in a murine model of sleep apnea with chronic intermittent hypoxia","author":"Seo","year":"2017","journal-title":"Sleep"},{"key":"R7-20260326","doi-asserted-by":"crossref","first-page":"5473","DOI":"10.3390\/ijerph19095473","article-title":"OSA and chronic respiratory disease: mechanisms and epidemiology","volume":"19","author":"Locke","year":"2022","journal-title":"Int J Environ Res Public Health"},{"key":"R8-20260326","doi-asserted-by":"crossref","first-page":"2374","DOI":"10.3390\/diagnostics12102374","article-title":"Obstructive sleep apnea and auditory dysfunction\u2014does snoring sound play a role?","volume":"12","author":"Lu","year":"2022","journal-title":"Diagnostics"},{"key":"R9-20260326","doi-asserted-by":"crossref","first-page":"681","DOI":"10.1111\/coa.13557","article-title":"Sleep apnoea is associated with hearing impairment: the Paris prospective study 3","volume":"45","author":"Lisan","year":"2020","journal-title":"Clin Otolaryngol"},{"key":"R10-20260326","doi-asserted-by":"crossref","first-page":"1170470","DOI":"10.3389\/fpubh.2023.1170470","article-title":"Is sleep apnea truly associated with hearing loss? A nationwide, population-based study with STOP-BANG questionnaire","volume":"11","author":"Lee","year":"2023","journal-title":"Front Public Health"},{"key":"R11-20260326","doi-asserted-by":"crossref","first-page":"e281","DOI":"10.1055\/s-0045-1809060","article-title":"Effects of continuous positive airway pressure on the degree of sleepiness, functional quality of sleep, and electrophysiological hearing responses in individuals with obstructive sleep apnea","volume":"18","author":"Farber","year":"2025","journal-title":"Sleep Sci"},{"key":"R12-20260326","doi-asserted-by":"crossref","first-page":"513","DOI":"10.1146\/annurev-publhealth-040119-094318","article-title":"Disparities in access to oral health care","volume":"41","author":"Northridge","year":"2020","journal-title":"Annu Rev Public Health"},{"key":"R13-20260326","doi-asserted-by":"crossref","first-page":"343","DOI":"10.2147\/CIA.S400032","article-title":"Association between oral health and swallowing function in the elderly","author":"Yamano","year":"2023","journal-title":"Clin Interv Aging"},{"key":"R14-20260326","doi-asserted-by":"crossref","first-page":"706","DOI":"10.1111\/joor.13472","article-title":"Impact of temporomandibular disorders on oral health\u2010related quality of life: a systematic review and meta\u2010analysis","volume":"50","author":"Qamar","year":"2023","journal-title":"J Oral Rehabil"},{"key":"R15-20260326","doi-asserted-by":"crossref","first-page":"641","DOI":"10.1007\/s11325-022-02668-1","article-title":"A meta-analysis on the association between obstructive sleep apnea and periodontitis","volume":"27","author":"Zhu","year":"2023","journal-title":"Sleep Breath"},{"key":"R16-20260326","doi-asserted-by":"crossref","first-page":"294","DOI":"10.1136\/postgradmedj-2020-137619","article-title":"The role of dry mouth in screening sleep apnea","volume":"97","author":"Zhang","year":"2021","journal-title":"Postgrad Med J"},{"key":"R17-20260326","doi-asserted-by":"crossref","first-page":"3935","DOI":"10.3390\/jcm12123935","article-title":"Evaluation of inflammation and oxidative stress markers in patients with Obstructive Sleep Apnea (OSA)","volume":"12","author":"Pau","year":"2023","journal-title":"J Clin Med"},{"key":"R18-20260326","doi-asserted-by":"crossref","first-page":"98","DOI":"10.1080\/00325481.2018.1396876","article-title":"Chronic periodontitis, inflammatory cytokines, and interrelationship with other chronic diseases","volume":"130","author":"Cardoso","year":"2018","journal-title":"Postgraduate Med"},{"key":"R19-20260326"},{"key":"R20-20260326","doi-asserted-by":"crossref","first-page":"121","DOI":"10.15724\/jslhd.2020.29.4.121","article-title":"Chewing and speaking difficulties, quality of life and depression in elderly Koreans: a survey of the Korea National Health and Nutrition Examination from 2016 \u223c 2018","volume":"29","author":"Im","year":"2020","journal-title":"Speech Lang Hearing"},{"key":"R21-20260326","doi-asserted-by":"crossref","first-page":"1173","DOI":"10.1037\/0022-3514.51.6.1173","article-title":"The moderator-mediator variable distinction in social psychological research: conceptual, strategic, and statistical considerations","volume":"51","author":"Baron","year":"1986","journal-title":"J Pers Soc Psychol"},{"key":"R22-20260326","doi-asserted-by":"crossref","first-page":"290","DOI":"10.2307\/270723","article-title":"Asymptotic confidence intervals for indirect effects in structural equation models","volume":"13","author":"Sobel","year":"1982","journal-title":"Sociol Methodol"},{"key":"R24-20260326","doi-asserted-by":"crossref","first-page":"e13637","DOI":"10.1111\/jsr.13637","article-title":"Prevalence of risk and factors associated with obstructive sleep apnea-hypopnea syndrome in an adult population in Kinshasa, Democratic Republic of Congo","volume":"32","author":"Tete","year":"2023","journal-title":"J Sleep Res"},{"key":"R25-20260326","doi-asserted-by":"crossref","first-page":"1951","DOI":"10.1001\/jama.2022.18357","article-title":"Screening for obstructive sleep apnea in adults: updated evidence report and systematic review for the US Preventive Services Task Force","volume":"328","author":"Feltner","year":"2022","journal-title":"JAMA"},{"key":"R26-20260326","doi-asserted-by":"crossref","first-page":"1908","DOI":"10.1001\/jama.2022.20670","article-title":"Screening for obstructive sleep apnea in adults","volume":"328","author":"Gottlieb","year":"2022","journal-title":"JAMA"},{"key":"R27-20260326","doi-asserted-by":"crossref","first-page":"560","DOI":"10.1038\/s41569-023-00846-6","article-title":"Obstructive sleep apnea heterogeneity and cardiovascular disease","volume":"20","author":"Redline","year":"2023","journal-title":"Nat Rev Cardiol"},{"key":"R28-20260326","doi-asserted-by":"crossref","first-page":"112014","DOI":"10.1016\/j.ijporl.2024.112014","article-title":"Is there an increased risk of otitis media in children with obstructive sleep apnea?","volume":"182","author":"Cottone","year":"2024","journal-title":"Int J Pediatr Otorhinolaryngol"},{"key":"R29-20260326","doi-asserted-by":"crossref","first-page":"201","DOI":"10.1177\/01945998221120777","article-title":"Obstructive sleep apnea and sensorineural hearing loss: a systematic review and meta-analysis","volume":"169","author":"Kasemsuk","year":"2023","journal-title":"Otolaryngol Head Neck Surg"},{"key":"R30-20260326","doi-asserted-by":"crossref","first-page":"2823","DOI":"10.1007\/s00784-023-04869-8","article-title":"Relationship of obstructive sleep apnea with periodontal condition and its local and systemic risk factors","volume":"27","author":"Arango Jimenez","year":"2023","journal-title":"Clin Oral Investig"},{"key":"R31-20260326","doi-asserted-by":"crossref","first-page":"e2023032","DOI":"10.4178\/epih.e2023032","article-title":"Risk of chronic periodontitis in patients with obstructive sleep apnea in Korea: a nationwide retrospective cohort study","volume":"45","author":"Kim","year":"2023","journal-title":"Epidemiol Health"}],"container-title":["Noise and Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ovid.com\/10.4103\/nah.nah_211_25","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T15:44:13Z","timestamp":1787067853000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ovid.com\/10.4103\/nah.nah_211_25"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,1]]},"references-count":30,"journal-issue":{"issue":"130","published-print":{"date-parts":[[2026]]}},"URL":"https:\/\/doi.org\/10.4103\/nah.nah_211_25","relation":{},"ISSN":["1463-1741"],"issn-type":[{"value":"1463-1741","type":"print"}],"subject":[],"published":{"date-parts":[[2026,1]]},"assertion":[{"value":"2025-10-20","name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-01-04","name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}}]}}