Obstructive sleep apnea (OSA) is more than a sleep disorder—it may play a significant role in mental health, especially for middle-aged and older adults. Recent research from Canada highlights a strong link between high OSA risk and increased chances of depression and other mental health conditions.
These findings underscore the need to consider sleep health as part of overall psychological well-being.
OSA and Mental Health Risk
A large longitudinal study conducted by Tetyana Kendzerska, MD, PhD, at the Ottawa Hospital Research Institute in Ontario, revealed that individuals with high OSA risk have about 40% higher odds of experiencing depression or physician-diagnosed mental health conditions compared to those at low risk. These results were reported in JAMA Network Open.
The associations remained consistent both at the study’s baseline and over nearly three years of follow-up. At baseline, the odds ratio was 1.39 (95% CI 1.28-1.50), and at follow-up, the odds ratio was 1.40 (95% CI 1.30-1.50). The strongest links were observed with self-reported mood disorders and clinical depression.
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High OSA risk in the study was determined by the presence of at least two of the following factors:
1. Snoring
2. Daytime sleepiness
3. Witnessed apnea episodes during sleep
4. Hypertension
These findings suggest that OSA may influence depressive states in older adults, potentially through effects on cardiovascular health, a known contributor to depression in this age group.
How Sleep Apnea Affects Mental Health
The connection between OSA and mental health appears to be bidirectional. Hypoxemia and sleep fragmentation caused by untreated OSA may contribute to the development or worsening of mental health conditions.
Conversely, existing mental health disorders can increase OSA risk due to weight gain, altered upper airway muscle tone, and changes in neuromuscular function linked to neurotransmitter imbalances and autonomic dysregulation.
Giulia Ogliari, MD, PhD, from the National Institute for Health and Care Research Health Determinants Research Collaboration in Leicestershire, noted that these mechanisms are particularly important for older adults, whose resilience may already be reduced due to multiple health conditions and polypharmacy.
Implications for Screening and Treatment
The study emphasizes that OSA should not be considered solely as a sleep or respiratory disorder. Its potential influence on mood and cognitive function makes it an important factor in psychological and neurological health in later life.
Researchers suggest that integrating mental health and sleep medicine could improve outcomes, encouraging clinicians to view OSA treatment as a strategy for protecting brain, mood, and cardiovascular health.
Traditionally, OSA treatment focuses on symptoms such as snoring, fatigue, or daytime sleepiness. However, these findings suggest that even individuals without severe symptoms might benefit from early intervention, particularly in the context of mental health prevention.
Study Details
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This research analyzed data from the Canadian Longitudinal Study on Aging, including 30,097 individuals aged 45 to 85 at baseline and 27,765 participants at follow-up, approximately 2.9 years later. At baseline, 23.5% of participants were classified as high risk for OSA, increasing slightly to 27.0% at follow-up.
Mental health outcomes were measured using multiple indicators, including:
1. Center for Epidemiologic Studies Short Depression Scale scores of 10 or higher
2. Kessler Psychological Distress Scale scores of 20 or higher
3. Self-reported physician-diagnosed mental health conditions
4. Antidepressant use
Repeated measures analysis showed that high OSA risk was associated with a 44% higher chance of mental health issues (OR 1.44, 95% CI 1.34-1.53).
Study Limitations
The researchers noted several limitations: the observational design cannot prove causality, sleep and mental health measures relied on self-reporting, and the study population was predominantly white, healthier, more educated, and urban, limiting generalizability.
Additionally, OSA treatment data were unavailable, leaving questions about how therapy might influence mental health outcomes.
This research highlights the intertwined nature of sleep and mental health, showing that OSA risk can significantly impact psychological well-being in middle-aged and older adults.
Recognizing sleep apnea as more than a breathing disorder opens new possibilities for prevention and treatment strategies that support brain, mood, and heart health.