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It is well known that the prevalence of sleep disordered breathing (SDB) is increased in patients with obesity or metabolic comorbidities. However, the way in which the prevalence of SDB increases in relation to comorbidities according to the severity of obesity remains unclear.This cross-sectional study evaluated 7713 community participants using nocturnal oximetry ≥2 nights. SDB was assessed by the 3% oxygen desaturation index corrected for sleep duration obtained by wrist actigraphy (acti-ODI3%). SDB severity was defined by acti-ODI3%. Obesity was defined as body mass index ≥25 kg·m -2 The prevalence of SDB was 41.0% (95% CI 39.9-42.1%), 46.9% (45.8-48.0%), 10.1% (9.5-10.8%) and 2.0% (1.7-2.3%) in normal, mild, moderate and severe SDB, respectively, with notable sex differences evident (males>post-menopausal females>premenopausal females). Comorbidities such as hypertension, diabetes and metabolic syndrome were independently associated with the prevalence of moderate-to-severe SDB, and coincidence of any one of these with obesity was associated with a higher probability of moderate-to-severe SDB (hypertension OR 8.2, 95% CI 6.6-10.2; diabetes OR 7.8, 95% CI 5.6-10.9; metabolic syndrome OR 6.7, 95% CI 5.2-8.6). Dyslipidaemia in addition to obesity was not additively associated with the prevalence of moderate-to-severe SDB. The number of antihypertensive drugs was associated with SDB (p for trend <0.001). Proportion of a high cumulative percentage of sleep time with oxygen saturation measured by pulse oximetry <90% increased, even among moderate-to-severe SDB with increases in obesity.Metabolic comorbidities contribute to SDB regardless of the degree of obesity. We should recognise the extremely high prevalence of moderate-to-severe SDB in patients with obesity and metabolic comorbidities., Competing Interests: Conflict of interest: T. Matsumoto has nothing to disclose. K. Murase reports grants from Philips-Respironics, Teijin Pharma, Fukuda Denshi, Fukuda Lifetec Keiji, ResMed and Japan Society for the Promotion of Science, outside the submitted work. Conflict of interest: Y. Tabara reports grants from Japan Agency for Medical Research and Development (AMED) and The Ministry of Education, Culture, Sports, Science and Technology in Japan, during the conduct of the study. Conflict of interest: T. Minami reports personal fees from Teijin Zaitakuiryou, outside the submitted work. Conflict of interest: O. Kanai has nothing to disclose. Conflict of interest: H. Takeyama reports grants from Philips-Respironics, ResMed, Fukuda Denshi, Fukuda Lifetec Keiji and Teijin Pharma, outside the submitted work. Conflict of interest: N. Takahashi reports grants from Philips-Respironics, ResMed, Fukuda Denshi and Fukuda Lifetec Keiji, outside the submitted work. Conflict of interest: S. Hamada reports grants from Teijin Pharma, outside the submitted work. Conflict of interest: K. Tanizawa has nothing to disclose. Conflict of interest: T. Wakamura has nothing to disclose. Conflict of interest: N. Komenami has nothing to disclose. Conflict of interest: K. Setoh has nothing to disclose. Conflict of interest: T. Kawaguchi has nothing to disclose. Conflict of interest: T. Tsutsumi has nothing to disclose. Conflict of interest: S. Morita has nothing to disclose. Conflict of interest: Y. Takahashi has nothing to disclose. Conflict of interest: T. Nakayama has nothing to disclose. Conflict of interest: T. Hirai has nothing to disclose. Conflict of interest: F. Matsuda reports grants from Kyoto University, the Ministry of Education, Culture, Sports, Science and Technology in Japan, Japan Agency for Medical Research and Development (AMED) and The Takeda Medical Research Foundation, during the conduct of the study. Conflict of interest: K. Chin reports grants from the Japanese Ministry of Education, Culture, Sports, Science and Technology, grants from the Intractable Respiratory Diseases and Pulmonary Hypertension Research Group, the Ministry of Health, Labour and Welfare, Japan, grants from the Research Foundation for Healthy Aging, grants from Health, Labour and Welfare Sciences Research Grants, Research on Region Medical, grants from the Center of Innovation Program, and the Global University Project from Japan Science and Technology Agency, Japan Agency for Medical Research and Development, during the conduct of the study; grants and personal fees from Philips-Respironics, Teijin Pharma, Fukuda Denshi, Fukuda Lifetec Keiji, GlaxoSmithKline and Resmed, grants from KYORIN Pharmaceutical Co., Ltd and Nippon Boehringer Ingelheim Co., Ltd, personal fees from MSD, Astellas Pharma and Eisai Co., Ltd, outside the submitted work., (Copyright ©ERS 2020.)