A longitudinal study with more than 30,000 participants found that the risk for OSA is associated with a 40% higher risk of poor mental health outcomes. The increased risk for anxiety, mood disorder, and depression was similar at baseline and after a mean of 2.9 years of follow-up. Over time, high risk of OSA was associated with a 44% increased risk of reporting one or more new mental health conditions.1
“There have been other studies published throughout the decades that have shown an association between untreated sleep apnea and higher incidences [of poor mental health outcomes],” said Colin Huntley, MD, Associate Professor of Otolaryngology – Head & Neck Surgery and Sleep Medicine at Thomas Jefferson University in Philadelphia. “This isn’t surprising, but it is a very large cohort of patients who are followed longitudinally. It provides an addition to the literature and helps to support what we’ve all suspected and encountered on a clinical basis.”
Researchers conducted a secondary analysis of the Canadian Longitudinal Study on Aging (CLSA) and the first follow-up study, which tracked 30,097 adults aged 45 to 85 years old at baseline across Canada between 2011 and 2018. CLSA is a nationwide, community-based prospective cohort study collecting data on multiple biological, medical, cognitive, psychological, social, lifestyle, and economic aspects of aging.1
Dr. Huntley said the sleep fragmentation, sympathetic activation, and intermittent hypoxemia common in OSA have been linked to cardiometabolic disease, greater health care utilization, increased traffic and workplace accidents, and reduced productivity. There is some evidence of a bidirectional link between OSA and the development and progression of mental health conditions, he said, although that is not yet proven by evidence.
For this analysis, the high risk of OSA was assessed using the validated STOP (snoring, tiredness, observed apnea, and high blood pressure) questionnaire. High OSA risk is defined as meeting any two of the four conditions that follow:
- Snoring
- Daytime somnolence
- Witnessed apnea during sleep
- Hypertension
Mental health outcomes were based on a composite of any of the following:
- A score of 10 or more on the Center for Epidemiologic Studies Short Depression Scale
- A score of 20 or more on the Kessler Psychological Distress Scale
- Self-reported physician diagnosis of a mental health condition
- Self-reported antidepressant use
The mean age of the cohort at baseline was 62 years old and 50.9% of participants were female. Nearly all participants (94.3%) were White. Most (83.3%) were from urban areas, and 89.2% had at least a high school education. High OSA risk was common, with 25.3% at baseline and 27.0% at follow-up.
Poor mental health, primarily mood disorder (17.1%) and clinical depression (16.3%), was identified in 34.4% of participants at baseline. At follow-up, 31.9% of participants had a composite outcome of poor mental health. Among individuals who did not meet the composite outcome at baseline, 6.9% met criteria for poor mental health at follow-up.
After adjusting for confounding factors, high risk of OSA was associated with an odds ratio (OR) of 1.39 for meeting criteria for poor mental health outcome at baseline (95% CI, 1.28-1.50) and 1.40 at follow-up (95% CI, 1.30-1.50). A repeated measures analysis found that high OSA risk was associated with an OR of 1.44 for the mental health outcome over time (95% CI,1.34-1.53).
“Data like this stays in your mind,” Dr. Huntley said. “We don’t do a standardized screening for mental health issues at our clinic, but there is a low threshold to bring up the possibility that sleep issues could be a contributing factor in patients with mental health comorbidities.”
Existing data also suggest that patients with sleep apnea and an existing mental health disorder might see mental health improvements if their sleep apnea can be better managed.
“The literature shows an association between treatment of sleep apnea and improvement in symptoms of mental health comorbidities, particularly depression and anxiety,” Dr. Huntley said. “The majority of this data has evaluated the impact of treatment of OSA with CPAP on mental health. However, there is data showing benefit with surgical treatments for OSA as well.
“Management of sleep-disordered breathing has a direct correlation with mental health. When evaluating patients for treatment of their OSA, CPAP is going to be the first thing we try in the majority of patients, but it’s certainly not the only option.”
References
1. Kendzerska T, Mallick R, Li W, et al. Obstructive sleep apnea risk and mental health conditions among older Canadian adults in the Canadian Longitudinal Study on Aging. JAMA Netw Open. 2025;8(12):e2549137. doi:10.1001/jamanetworkopen.2025.49137
