Long-term CPAP Use Linked With Improved Sleepiness, Depressive Symptoms in Patients With OSA

Patients with obstructive sleep apnea (OSA) exhibited improvements in sleepiness, depressive, and anxiety symptoms after 3 years of continuous positive airway pressure therapy (CPAP) use, although higher adherence to CPAP was linked with weight gain.

Use of continuous positive airway pressure therapy (CPAP) among patients with obstructive sleep apnea (OSA) was associated with improvements in sleepiness, depressive, and anxiety symptoms after 3 years, according to study findings published in the European Clinical Respiratory Journal.

In assessing risk for OSA, excess weight plays a significant factor, as study authors note that more than 70% of patients with the condition are overweight or obese. As the current gold standard for treating OSA, CPAP therapy is known to reduce daytime sleepiness, which researchers say may “in turn, improve diet, increase physical activity, and result in weight loss,” but research has not validated this hypothesis. It has instead been suggested that active weight reduction programs should be combined with CPAP therapy.

Moreover, patients with OSA have been found to experience adverse quality-of-life symptoms, chiefly depression and anxiety. CPAP therapy has been shown in prior studies to have an effective, yet controversial, impact on depressive symptoms, as research on this association, along with analyses on potential benefits in anxiety, remains limited.

Seeking to better understand the influence of long-term CPAP therapy on mood and sleepiness, as well as factors that may influence weight, researchers conducted a prospective study among patients referred to the Department of Pulmonary Diseases at Turku University Hospital, from March 2004 to October 2006, with symptoms suggesting OSA (N = 223; 54.7% women).

Patients underwent an overnight in-hospital cardiorespiratory polygraphy at baseline and completed a series of questionnaires, including the Epworth Sleepiness Scale, Pittsburgh Sleep Quality Index, depression scale, State-Trait Anxiety Inventory, and visual analogue scales to assess hunger, thirst, appetite, food quantities, nausea, and and craving for different food categories.

Questionnaires were repeated after 3 years among the 149 patients who completed the follow-up, in which a little more than half of participants used CPAP (n = 76).

At baseline, CPAP users were indicated to have more depressive symptoms and higher body mass index and apnea-hypopnea index scores compared with nonusers. In the follow-up, weight gain was not found to be associated with severity of OSA, depressive symptoms, anxiety, sleep quality, exercise habits or duration, or craving for distinct food categories at baseline for both CPAP users and nonusers. Notably, high adherence to CPAP therapy was the only factor associated with weight gain.

Among CPAP users, depressive symptoms decreased significantly compared with nonusers (P = .002), with sleepiness (P = .031) and sleep quality (P < .001) shown to improve more in CPAP users than in nonusers. Anxiety was also found to be decreased among the CPAP users, in contrast with nonusers, who reported a slight increase at follow-up.

“This research provides further evidence that long-term CPAP therapy in patients with OSA not only decreases sleepiness and improves sleep quality, but could also alleviate depressive symptoms and anxiety,” said the study authors.

Researchers highlighted that study findings reinforce that CPAP therapy alone is not sufficient for weight management in patients with OSA. “We advise on life-style counseling and weight management program to all patients with obesity on CPAP therapy.”


Aro MM, Anttalainen U, Polo O, Saaresranta T. Mood, sleepiness, and weight gain after three years on CPAP therapy for sleep apnoea. Eur Clin Respir J. Published online February 17, 2021. doi:10.1080/20018525.2021.1888394