Researchers at Ottawa Hospital Research Institute and University of Ottawa found that high risk of obstructive sleep apnea was associated with approximately 40% higher odds of a composite poor mental health outcome at baseline and follow-up among adults aged 45–85 years in the Canadian Longitudinal Study on Aging.
Mental health strains
Identifying factors associated with mental health outcomes is an important goal on several fronts. Mental health conditions rank among the leading contributors to global disease burden, with anxiety and depressive disorders described as most common. Individuals living with mental health conditions face higher risks of cardiometabolic diseases, unemployment, homelessness, disability, and hospitalizations. Economically, mental disorders carry an estimated $1 trillion annual global cost in lost productivity.
Obstructive sleep apnea (OSA) involves repeated upper airway narrowing during sleep. Disturbed breathing can break up sleep (sleep fragmentation), trigger a stress response in the nervous system (sympathetic activation), and cause episodes of low oxygen in the blood (intermittent hypoxemia).
Untreated OSA may be associated with development and progression of mental health conditions through hypoxemia and sleep fragmentation. Or, it may be brought on or exacerbated by mental health conditions due to autonomic imbalance, neurotransmitter dysregulation, and neuromuscular impairment. Existing research on the intersection has been limited.
National cohort and measures
In the study, “Obstructive Sleep Apnea Risk and Mental Health Conditions Among Older Canadian Adults in the Canadian Longitudinal Study on Aging,” published in JAMA Network Open, researchers conducted a cohort study secondary analysis to evaluate whether high risk of OSA was associated with increased odds of concurrent and future mental health conditions among middle–aged and older adults.
At baseline, 30,097 adults aged 45–85 years took part, with follow-up data available for 27,765 participants after a median of 2.9 years.
High risk of obstructive sleep apnea was defined with a sleep questionnaire score of 2 or higher, based on snoring, daytime somnolence, witnessed apnea during sleep, or hypertension.
Composite poor mental health outcome was defined as meeting any of four criteria, including a Center for Epidemiologic Studies Short Depression Scale score of 10 or more, a Kessler Psychological Distress Scale score of 20 or more, self-reported physician-diagnosed mental health condition, or self-reported antidepressant use. Logistic regression models were used to examine associations.
Odds across time points
High risk of obstructive sleep apnea was present in 7,066 of 30,097 participants at baseline, or 23.5%, and in 7,493 of 27,765 participants at follow-up, or 27.0%.
Poor mental health was counted as present if a participant met any one of four criteria, including symptom scores above the paper’s cutoffs, a self-reported doctor diagnosis, or antidepressant use. Using that combined definition, 10,334 of 30,097 participants met criteria at baseline, or 34.3%, and 8,851 of 27,765 participants met criteria at follow-up, or 31.9%.
After accounting for other measured factors that could affect both sleep apnea risk and mental health, participants at high risk of obstructive sleep apnea had higher odds of meeting the paper’s combined “poor mental health” definition at baseline, with odds ratio 1.39, and 1.40 at follow-up.
Among participants who did not meet the paper’s combined “poor mental health” definition at baseline, high risk of obstructive sleep apnea was associated with higher odds of meeting that combined definition by follow-up, with odds ratio 1.20. Looking across baseline and follow-up together in a single analysis, high risk of obstructive sleep apnea was associated with odds ratio 1.44 for meeting the combined definition.
Secondary analyses using witnessed apnea during sleep and physician-diagnosed anxiety disorder, mood disorder, and clinical depression as separate outcomes showed similar patterns.
Implications for screening and care
Hypoxemia, sleep fragmentation, and inflammation were found to be potential pathways linking untreated OSA with mental health conditions, with OSA-related cardiometabolic comorbidities described as another contributor to mental distress. Higher odds of new mental health conditions at follow-up were associated with several individual factors among participants at high risk of OSA.
The authors recommend making depression and anxiety checks a routine step when older adults show signs that suggest sleep apnea risk.
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More information
Tetyana Kendzerska et al, Obstructive Sleep Apnea Risk and Mental Health Conditions Among Older Canadian Adults in the Canadian Longitudinal Study on Aging, JAMA Network Open (2025). DOI: 10.1001/jamanetworkopen.2025.49137
Journal information:
JAMA Network Open
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