PurposeThis study aims to examine the relationship between obstructive sleep apnea (OSA) risk, as assessed by the STOP-Bang questionnaire, and couples' self-rated health. It also investigates how sleep behaviors (snoring, daytime tiredness, and observed apnea) reported in the STOP-Bang items affect couples' self-rated health.MethodsData from the Korea National Health and Nutrition Examination Survey (2019-2021) were analyzed, including 2,498 couples with complete STOP-Bang and self-rated health data. Logistic regression was used to explore these associations.Results59.2% of husbands and 11.0% of wives were at high risk for OSA. After adjusting for sociodemographic factors, comorbidities, and health behaviors, OSA risk and daytime tiredness were associated with poor self-rated health in both spouses (OR 1.52-3.38 in husbands, 2.23-2.63 in wives). After adjusting for these confounding factors and individual OSA risk, husbands whose wives reported snoring or daytime tiredness had higher odds of self-rated poor health (OR 2.69 [95% CI: 1.63-4.43] and 1.75 [95% CI: 1.25-2.45], respectively) compared to husbands whose wives did not report these behaviors. However, wives' self-rated health was not significantly influenced by their husbands' sleep behaviors. Additionally, the adjusted odds of self-rated poor health were 1.51 (95% CI: 1.06-2.16) in husbands if either partner had a high OSA risk, and 1.83 (95% CI: 1.15-2.90) in wives if both partners had a high OSA risk.ConclusionHusbands' self-rated poor health is associated with wives' snoring and daytime tiredness. The presence of OSA in one or both partners was also associated with poorer perceived health in the couple.