It’s not uncommon for individuals with obstructive sleep apnea (OSA) to also experience mental health conditions such as depression and anxiety. Approximately 35% of those with OSA report coexisting depression, while nearly 44% experience anxiety.1 For individuals with severe OSA, the likelihood and prevalence of these mental health conditions are significantly higher, often accompanied by pronounced depressive symptoms.2-5
Each of these conditions carries with it substantial health implications, but the coexistence—and overlap in symptoms with OSA—introduces heightened risks and complex challenges for patients and clinicians alike. When either condition is left untreated, one can exacerbate the other, negatively impacting quality of life and emotional well-being.6
As a sleep disorder characterized by repeated interruptions in night-time breathing, people with OSA often present with symptoms such as fatigue, low energy or impaired focus—symptoms that are also common in depression and anxiety.7-9 Both depression and anxiety can interfere with daily activities and impact all aspects of life, including relationships with family, friends and community, and functioning in social situations or at work.8,9 When compounded with the lack of sleep resulting from OSA, the impact could be even greater. This overlap and convergence of symptoms can also confuse diagnosis, leaving OSA undetected in many cases.6 For example, fatigue could be misinterpreted purely as a symptom of depression, delaying accurate intervention for OSA.
Furthermore, the relationship between these conditions is two-way. Both OSA and depression are linked with systemic inflammation,10,11 which can contribute to the severity of symptoms in both disorders. The physiological disruptions caused by OSA, like sleep fragmentation and oxygen desaturation, may contribute to the development of depression and anxiety, or aggravate depressive symptoms such as fatigue and mood changes.3,12 At the same time, untreated mental health conditions can reduce a patient's ability or willingness to comply with OSA therapies like positive airway pressure (PAP).13 Together, these conditions could lead to a vicious cycle of worsening symptoms unless both are proactively identified and treated.
The prevalence and experience of and mental health differs across genders in significant ways. Research has consistently shown that women are more likely than men to experience both anxiety and depression.8,9 The rate of anxiety in women is 50% higher than it is in men,14 while up to twice as many women as men experience major depressive disorder.15 These differences are often attributed to hormonal and neurological factors, but lifestyle and social factors also play a role.16
In addition, women with OSA report significantly worse depression and anxiety than their male counterparts.17 This disparity may be influenced by the different ways men and women experience and report symptoms, as well as how they respond to stress and illness, and suggests a greater impact on quality of life for women with OSA.
Additionally, OSA often manifests differently in women. Traditional symptoms like heavy snoring and gasping for air during sleep may be less pronounced, while fatigue and mood changes dominate the clinical picture.18 These differences may lead to delayed diagnoses in women, thereby increasing the risk of their mental health conditions going untreated.
Effective treatment requires an accurate understanding of how OSA and mental health conditions coexist. For people with depression and OSA, treating OSA has been shown to improve depressive symptoms and response to antidepressant therapy.19,20 It is also associated with a decrease in hospitalizations, emergency room visits and incidents of self-harm.21
Knowing that treating only mental health without addressing OSA can leave patients struggling with persistent symptoms highlights the need for timely diagnosis, tailored treatments and integrated care for people with both OSA and depression. When this happens, it can be possible to break the cycle of poor health among patients with OSA and comorbid depression or anxiety, delivering both better sleep and improved mental well-being.