January/February 2026
High risk of obstructive sleep apnoea linked to poorer mental health in older adults
By Sasha Ellery BM BCh
Middle-aged and older adults at high risk of obstructive sleep apnoea (OSA) have higher odds of depression, psychological distress and other markers of poor mental health, suggests a large Canadian cohort study published in JAMA Network Open.
Researchers performed a secondary analysis of data from the Canadian Longitudinal Study on Aging, including 30,097 community-dwelling adults aged 45 to 85 years at baseline and 27,765 at follow up, with a median follow up of 2.9 years. Participants were classified as at ‘high risk’ of OSA if they scored 2 or more on the STOP questionnaire (snoring, daytime somnolence, witnessed apnoea during sleep or hypertension).
The primary outcome was a composite ‘poor mental health’ measure defined by any of: a Center for Epidemiologic Studies Short Depression Scale score of 10 or more; a Kessler Psychological Distress Scale score of 20 or more; self-reported physician-diagnosed mental health condition; or self-reported antidepressant use. Researchers found that high OSA risk was associated with about 40% higher odds of the composite outcome at both baseline and follow up.
Dr Chris Blackwell, a Psychiatrist at the Woolcock Institute of Medical Research, Sydney, with a special interest in the relationship between sleep and psychiatric illness, said the paper highlighted that people with OSA, or who were at risk of OSA, were significantly more prone to having a wide variety of mental health issues.
‘It also highlights that OSA could present as a mental health issue,’ he said.
‘We see populations of postmenopausal women who present with anxiety, when the issue that brings them there is that they have OSA. Because they’re having fragmented sleep, they feel tired, anxious or have trouble managing day-to-day. You need to treat their OSA and their anxiety at the same time, and there’s synergistic benefit to doing both.’
The researchers also found that new-onset poor mental health during follow up was more likely in the high-risk OSA group in those: who were female, had lower household income, were neutral to or dissatisfied with life, had fair self-rated general health and who had reported other sleep problems (e.g. insomnia symptoms, restless legs).
‘There’s a complex relationship here in all directions. For GPs – who are best at picking up these presentations in the general population – if you’re seeing patients with established mental health issues, screening for OSA is a very important part of improving their management, and improving their long-term survival and health outcomes,’ Dr Blackwell told Medicine Today.
The researchers said their findings addressed gaps in the knowledge about the link between OSA and mental health during ageing, and emphasised the need for more integrated approaches to screening for OSA and mental health conditions.
‘In general, OSA is an eminently treatable condition,’ Dr Blackwell explained. ‘And improving people’s sleep can improve their mental health outcomes as well. That’s why GPs screening for OSA – particularly in people who present with mental health problems – and treating it is likely to improve outcomes. It’s underdiagnosed in this group, so patterns like these are really helpful at every level.’