How Do Anxiety, Depression Affect Severity of Obstructive Sleep Apnea?

Among patients with obstructive sleep apnea (OSA), the presence of anxiety was shown to have an inverse relationship with the severity of OSA, whereas symptoms of depression did not exhibit a similar relationship.

Among patients with obstructive sleep apnea (OSA), anxiety was shown to have an inverse relationship with the severity of OSA, whereas symptoms of depression did not result in a similar relationship, according to study findings published in Cureus.

Although mood disorders are often associated with OSA, the researchers highlight that these interactions are not well understood. “OSA is known to have significant neuropsychiatric manifestations,” they said. “These may be related to both the neurobehavioral effects of intermittent hypoxia as well as the effects of sleep fragmentation.”

In seeking to better understand the relationship of anxiety and depression with OSA, theresearchers hypothesized that individuals with more severe OSA would have more severe symptoms of anxiety and depression.

Testing their hypothesis, the study authors assessed patients (N = 45) undergoing polysomnography from May to September 2006 at the Baylor College of Medicine Sleep Center, who additionally completed demographic questions (self-reported age, gender, ethnicity), the Epworth Sleepiness Scale, and the Hospital Anxiety and Depression Scale (HADS). Results of the HADS questionnaire were indicated as abnormal if the score was 8 and above.

Of the 45 participants recruited, 28 scored positive for anxiety and 29 were positive for depression. The patients with anxiety had a lower median score on the apnea-hypopnea index (AHI), the current standard that determines severity of sleep apnea, vs those without anxiety: 21.4 (interquartile ratio [IR], 9.6-41.3) vs 50.5 (IR, 25.1-94.3; P = .0076).

Additionally, the peripheral oxygen saturation (SpO2) nadir was indicated as less abnormal in patients with anxiety than those without (80% vs 65%; P = .0007), as was time with SpO2 < 90% (11 vs 36 minutes; P = .0002). The anxiety score on the HADS was shown to correlate (r) weakly with the AHI (r = -0.29).

Conversely, patients with depression were not significantly different those those without depression when examining AHI, SpO2 nadir, and time with SpO2 < 90%. 

In addressing the study findings, the researchers say that the inverse relationship uncovered between OSA severity and presence of anxiety suggests that comorbid anxiety may prompt sleep evaluation in less severe disease, warranting further investigation.

“Understanding these relationships may provide essential information to better treat patients and help identify patients that may have underlying psychiatric disease,” concluded the study authors.


Akberzie W, Hesselbacher S, Aiyer I, Surani S, Surani ZS. The prevalence of anxiety and depression symptoms in obstructive sleep apnea. Cureus. Published online October 27, 2020. doi:10.7759/cureus.11203