Study objective Since, OSA affects various parts of the body, there has been little interest about the effect of OSA on voice. The objective of this study was to evaluate the risk of benign vocal fold lesions (BVFL) in OSA patients Methods This retrospective cohort study used data from the National Health Insurance Service (NHIS) database. The study group was defined as the group diagnosed with OSA between 2008 and 2011. Non-OSA groups were selected based on propensity score matching. Incidence of BVFL among participants during the follow-up was analyzed. Cox proportional hazard regression analyses were performed to evaluate the association between OSA and incident BVFL. Results The HR value of the OSA group calculated by considering eight variables indicates that the risk of developing BVFL is 79% higher than that of the control group. Further, among OSA patients, patients with a history of OP had a 35% lower risk of developing BVFL. The relationships between BVFL and seven individual variables considered were as follows: 1) For age, HR for the 40-59 years group was 1.20 (95%CI, 1.09-1.32). 2) For sex, the HR in the female group was 1.22 (95%CI, 1.10-1.35). 3) For residential areas, the HR values for “Seoul” 1.39(95%CI, 1.23-1.59). 4) In the high economic status group, the HR was 1.10 (95%CI, 1.01-1.21). Conclusions and Relevance This observational study indicated that OSA is associated with an increased incidence of BVFL. The incidence of BVFL increased with older age, female sex, and high SES.