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January 07, 2026
4 min read
Key takeaways:
- Individuals at high risk for OSA had a score of at least two on the STOP questionnaire.
- At both baseline and follow-up, there was a link between high OSA risk and elevated odds for poor mental health outcomes.
Being at high risk for obstructive sleep apnea as a middle-aged and older adult was linked to a greater likelihood for poor mental health outcomes, according to findings published in JAMA Network Open.
“For the practicing clinician, these findings support viewing obstructive sleep apnea risk as a meaningful mental health-relevant condition in older adults, not solely a sleep or cardiometabolic issue,” Tetyana Kendzerska, MD, PhD, associate scientist of inflammation and chronic disease at Ottawa Hospital Research Institute, associate professor of medicine at the University of Ottawa and sleep physician at the Ottawa Hospital, told Healio.
Patients with a high risk for OSA are more likely to experience simultaneous mental health conditions as well as develop new ones, she continued, suggesting that clinicians should consider routine mental health screening when evaluating patients for OSA.
“Conversely, clinicians caring for older adults with depression or anxiety should maintain a high index of suspicion for undiagnosed sleep apnea,” Kendzerska said. “Incorporating brief mental health assessments into sleep evaluations and educating patients about the broader neuropsychological consequences of untreated OSA may support earlier identification, more comprehensive care, and improved engagement with diagnostic testing and treatment.”
In a cohort study, Kendzerska and colleagues assessed 30,097 adults aged 45 to 85 years (median age, 62 years; 50.9% women) from the national community-based prospective Canadian Longitudinal Study on Aging Baseline Comprehensive Cohort (2011-2015) and 27,765 adults (median age, 65 years; 50.9% women) from the first follow-up (2015-2018) to determine the link between high risk for OSA and odds for concurrent and future mental health conditions.
“OSA is common, frequently underdiagnosed and biologically well positioned to influence mental health through pathways such as intermittent hypoxemia, sleep fragmentation, autonomic activation, inflammation and downstream cardiometabolic comorbidity,” Kendzerska said.
However, Kendzerska noted that existing literature on the link between these two conditions has been limited by three factors: small or single center samples, cross-sectional designs and inadequate control for confounding.
“At the same time, OSA remains under-recognized and undertreated among individuals with mental health conditions, raising concern that a modifiable contributor to psychological morbidity is being missed,” Kendzerska told Healio.
Researchers deemed an individual at high risk for OSA if they had a score of at least two on the STOP questionnaire, and 23.5% of middle-aged and older adults in the baseline cohort and 27% of adults in the follow-up cohort met this criterion.
To identify individuals with mental health conditions, researchers used a composite poor mental health outcome, which was made up of a Center for Epidemiologic Studies Short Depression Scale score of at least 10, a Kessler Psychological Distress Scale score of at least 20, a self-reported physician-diagnosed mental health condition and self-reported antidepressant use.
In the baseline cohort, 34.3% of adults had any of the above mental health factors, and in the follow-up cohort, this was true for 31.9% of adults.
The confounder-adjusted likelihood for the composite mental health outcome was significantly elevated at baseline among those with a high risk for OSA (adjusted OR = 1.39; 95% CI, 1.28-1.5), according to the study. The adjusted analysis also showed that the odds for the composite outcome at follow-up were significantly raised among those with a high risk for OSA (aOR = 1.4; 95% CI, 1.3-1.5).
Researchers continued to find a heightened likelihood for the composite outcome among adults with a high risk for OSA in a confounder-adjusted repeated-measures analysis (OR = 1.44; 95% CI, 1.34-1.53).
Notably, in the set of adults who did not meet criteria for poor mental health at baseline, the adjusted odds for developing the mental health outcome at follow-up were increased if they had a high risk for OSA (aOR = 1.2; 95% CI, 1.03-1.4).
“High OSA risk was associated with approximately 40% higher odds of mental health conditions both cross-sectionally and longitudinally and remained associated with a similar increase in the odds of new mental health conditions over time,” Kendzerska told Healio.
“What was particularly informative was the persistence of these associations after extensive adjustment and sensitivity analyses, suggesting that the relationship is not explained solely by demographics, comorbidity burden or medication use,” she continued.
When using witnessed apnea during sleep instead of a high risk for OSA, researchers continued to find elevated odds for the composite poor mental health outcome among those with witnessed apnea.
Similarly, when the mental health outcome was broken down into three components (anxiety disorder, mood disorder and clinical depression), increased odds for these outcomes were observed among those with high risk of OSA and those with witnessed apnea.
Additionally, in those at high risk for OSA, researchers found links between several characteristics and increased odds for new composite mental health conditions at follow-up via multivariable analyses: female sex, a total household income of less than $50,000, being dissatisfied or neutral vs. satisfied or extremely satisfied with life, fair vs. excellent self-rated general health and sleep disorders such as restless legs, acting out on dreams and insomnia symptoms.
Eight more characteristics linked to worsening on the composite mental health outcome from baseline to follow-up were uncovered in a repeated-measures analysis, according to the study.
“We identified clinical characteristics, including respiratory comorbidity, pain, co-existing other sleep disorders (such as insomnia) and polypharmacy, that appear to identify individuals with suspected sleep apnea who are at particularly high risk for mental health conditions,” Kendzerska said. “While interaction analyses were not statistically significant, there was a signal suggesting a potentially stronger association in females, which may warrant further study.”
Looking ahead, Kendzerska highlighted several other possible directions for future research on this topic.
“Future studies will move beyond risk associations to evaluate whether integrated screening and prevention strategies for OSA can improve both mental health and cognitive outcomes, particularly given emerging links between OSA, cognitive impairment and dementia,” she told Healio.
“There is also a need to examine whether clinical characteristics that commonly co-occur in individuals at high OSA risk help identify subgroups at especially high risk for developing mental health conditions, and whether targeted, coordinated care in these groups improves outcomes,” Kendzerska added. “Identifying high-risk subpopulations will be particularly important for guiding mental health prevention efforts in resource-limited settings, where individuals with co-existing sleep and mental health conditions often have substantial unmet care needs despite frequent health care contact.”
For more information:
Tetyana Kendzerska, MD, PhD, can be reached at tkendzerska@toh.ca.
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