Sleep Apnea Risk Tied to 40% Higher Odds of Poor Mental Health

Middle-aged and older adults at high risk of obstructive sleep apnea (OSA) face significantly worse mental health outcomes, both concurrently and over time, according to a new national cohort study from Canada.¹ The findings, published in JAMA, add longitudinal evidence to a growing body of research linking sleep-disordered breathing with depression, psychological distress, and other mental health conditions as people age.

An estimated 936 million adults aged 30 to 69 are affected by OSA globally,² and 90% of cases are undetected.³ To address this gap, researchers conducted a secondary analysis of data from the Canadian Longitudinal Study on Aging (CLSA), a community-based prospective cohort that follows adults across biological, psychological, social, and lifestyle domains of aging.¹ The analysis included 30,097 participants aged 45 to 85 years from the CLSA Baseline Comprehensive Cohort (2011–2015) and 27,765 participants who completed follow-up 1 (2015–2018), with a median follow-up of 2.9 years. Statistical analyses were performed in October 2024.

The STOP questionnaire, which captures snoring, daytime sleepiness, witnessed apnea, and hypertension, was employed to assess the risk of OSA. Participants with a score of 2 or higher were classified as being at high risk for OSA. Mental health outcomes were measured using a composite binary variable that captured poor mental health, defined by at least one of the following: elevated depressive symptoms on the Center for Epidemiologic Studies Depression Scale (CES-D-10), high psychological distress on the Kessler Psychological Distress Scale (K10), self-reported physician-diagnosed mental health conditions, or antidepressant use.

At baseline, nearly a quarter of participants (23.5%) were classified as being at high risk of OSA, increasing to 27.0% at follow-up. Witnessed apnea during sleep was reported by 14.1% of participants at baseline and 16.8% at follow-up. Poor mental health was common, affecting 34.3% of participants at baseline and 31.9% at follow-up. Mood disorders and clinical depression were the most prevalent conditions, with mean CES-D-10 and K10 scores indicating mild to moderate symptom levels across the cohort.

After adjusting for a wide range of potential confounders, including sociodemographic factors, health behaviors, and chronic conditions, high risk of OSA was consistently associated with worse mental health. Cross-sectional analyses showed that participants at high risk of OSA had approximately 40% higher odds of meeting criteria for the composite mental health outcome at both baseline (OR, 1.39; 95% CI, 1.28–1.50) and follow-up (OR, 1.40; 95% CI, 1.30–1.50).

Importantly, the association extended beyond concurrent symptoms. Among nearly 20,000 participants who did not meet criteria for poor mental health at baseline, those at high risk of OSA had a 20% higher likelihood of developing poor mental health by follow-up (OR, 1.20; 95% CI, 1.03–1.40). Repeated-measures analyses that accounted for changes over time further strengthened the findings, showing a 44% higher odds of poor mental health associated with high OSA risk (OR, 1.44; 95% CI, 1.34–1.53).

Secondary analyses reinforced the robustness of the results. Similar associations were observed when OSA risk was defined using witnessed apnea alone and when mental health outcomes were examined individually rather than as a composite. Modest but statistically significant associations were also found between OSA risk and worsening depressive and psychological distress symptoms over time, as measured by continuous CES-D-10 and K10 scores.

Taken together, the results highlight OSA as an important, potentially modifiable risk factor for poor mental health in aging populations. "Findings from our study address knowledge gaps regarding the association between high risk of OSA and mental health and provide valuable information for future intervention studies to develop and evaluate screening programs to protect the mental health of older adults at high risk of OSA," the authors concluded.

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 Network Open. 2025;8(12):e2549137. doi:10.1001/jamanetworkopen.2025.49137
2. Benjafield AV, Ayas NT, Eastwood PR, et al. Estimation of the global prevalence and burden of obstructive sleep apnoea: a literature-based analysis. Lancet Respir Med. 2019;7(8):687-698. doi:10.1016/S2213-2600(19)30198-5
3. Young T, Evans L, Finn L, Palta M. Estimation of the clinically diagnosed proportion of sleep apnea syndrome in middle-aged men and women. Sleep. 1997;20(9):705-706. doi:10.1093/sleep/20.9.705