OSA and depression: The overlap and benefits of treatment

Category: Sleep Health & Disorders , Treatment & Therapy

Topic: Comorbidities & Other Conditions, PAP Therapy & Adherence, Symptoms & Presentation, Primary Care & Sleep Health

People with obstructive sleep apnea (OSA) are not only at increased risk of depression, but the more severe their OSA is, the more likely they are to develop depression.^1-4

Understanding the interplay between OSA and depression can be step one in helping people feel ready to tackle their OSA as part of managing their mental and physical health.

OSA Prevalence

~35% of people with OSA will have depressive symptoms.⁵
The rate of comorbid OSA in patients with depression ranges from 36% to 48%.⁶
People with OSA are more likely to have depressive symptoms when their OSA is severe.⁷

36-48%

of people with depression have comorbid OSA

Risk

People with OSA are at greater risk of depression and anxiety than people who do not have OSA.^8-10
The risk of comorbid depression and anxiety may be higher in women than in men.¹⁰

Symptoms and presentation

Many symptoms of OSA and depression are similar.¹¹
Some patients with OSA will present with depression symptoms.¹²
The overlap of symptoms and presentation sometimes results in underdiagnosis of OSA in people with depression.¹¹

Table

Benefits of OSA treatment

Patients with OSA presenting with depression symptoms see improvement of those symptoms when their OSA is treated with PAP therapy.¹²
Treatment of OSA with PAP improves emotional regulation¹³ and sleep quality.¹⁴
In patients with depression and OSA, adherence to PAP therapy has been linked to decreased emergency room visits and hospital stays.⁶

Key takeways

Depression may be a symptom of, or exacerbated by, OSA, and having OSA (especially severe OSA) increases the risk of depression.
OSA may remain undiagnosed in many patients with OSA because of the similarity between symptoms of both OSA and depression.¹¹
Patients presenting with symptoms of OSA and/or depression should be screened and tested for both conditions.
Patients can benefit by being encouraged and supported to treat OSA, knowing that doing so may also help coexisting depression.

Liu Q, He H, Yang J, et al. Changes in the global burden of depression from 1990 to 2017: Findings from the Global Burden of Disease study. J Psych Res 2020;126:134-40.

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;7:687-98.

Peppard PE, Young T, Barnet JH, et al. Increased prevalence of sleep-disordered breathing in adults. Am J Epidemiol 2013;177:1006-14.

BaHammam AS, Kendzerska T, Gupta R, et al. Comorbid depression in obstructive sleep apnea: an under-recognized association. Sleep Breath 2016;20:447-56.

Garbarino S, Bardwell WA, Guglielmi O, et al. Association of anxiety and depression in obstructive sleep apnea patients: a systematic review and meta-analysis. Behav Sleep Med 2020;18:35-57.

Wickwire EM, Cole KV, Dexter RB, et al. Depression and comorbid obstructive sleep apnea: Association between positive airway pressure adherence, occurrence of self-harm events, healthcare resource utilization, and costs. J Affect Disord 2024;349:254-61.

Li M, Zou X, Lu H, et al. Association of sleep apnea and depressive symptoms among US adults: a cross-sectional study. BMC Public Health 2023;23:427.

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Jehan S, Auguste E, Pandi-Perumal SR, et al. Depression, obstructive sleep apnea and psychosocial health. Sleep Med Disord 2017;1.

Schwartz DJ, Kohler WC, Karatinos G. Symptoms of depression in individuals with obstructive sleep apnea may be amenable to treatment with continuous positive airway pressure. Chest 2005;128:1304-9.

Pattison E, Tolson J, Barnes M, et al. Improved depressive symptoms, and emotional regulation and reactivity, in individuals with obstructive sleep apnea after short- and long-term CPAP therapy use. Sleep Med 2023;111:13-20.

Loredo JS, Ancoli-Israel S, Kim E-J, et al. Effect of continuous positive airway pressure versus supplemental oxygen on sleep quality in obstructive sleep apnea: a placebo-CPAP−controlled study. Sleep 2006;29:564-71.