To assess the prevalence of symptoms and risks of obstructive sleep apnea (OSA) in a sample of middle-aged Saudi women in a primary care using a validated questionnaire. In this cross-sectional study, trained medical students administered the Berlin Questionnaire to a consecutive random sample of Saudi women in the age group 35-60 years, attending the primary health care center in King Khalid University Hospital, Riyadh, Kingdom of Saudi Arabia, between January and July 2007. Based on the questionnaire, individuals were classified into high-risk and low-risk groups for OSA. Four hundred women with a mean body mass index of 31.3+7.2 kg/m2 were surveyed in this study. Among the study group, 40.8% reported snoring (everyday in 15%, 3-4 times a week in 7.5%, and one-2 times a week in 9.8%). Breathing pauses more than 3 times per week was present in 22.5%. Hypertension was present in 24.8%. Based on the Berlin Questionnaire stratification for risk of OSA, 39% were considered as high-risk patients for OSA. In the primary care setting, the prevalence of symptoms of OSA among middle-aged Saudi women is very high. Almost 4 out of 10 middle-aged Saudi women are at risk for OSA, and may benefit from proper evaluation for OSA.