The study was led by Dr. Tetyana Kendzerska from the Inflammation and Chronic Disease Program at the Ottawa Hospital Research Institute and colleagues, using data from the Canadian Longitudinal Study on Aging (CLSA). While biological and behavioral pathways connecting OSA with depression and psychological distress have long been proposed, large prospective studies drawn from representative populations have been limited.
The analysis aimed to address that gap by examining whether a high risk of OSA is associated with concurrent and future mental health conditions among middle-aged and older adults.
Researchers conducted a secondary analysis of CLSA participants aged 45 to 85 years at baseline, drawing on data collected between 2011 and 2015 and follow-up assessments conducted from 2015 to 2018. The CLSA is a nationwide, community-based cohort designed to capture a broad range of health, psychological, social, and lifestyle factors related to aging. OSA risk was assessed using the STOP questionnaire, with individuals scoring two or more considered at high risk.
Mental health outcomes were evaluated using a composite measure that included depressive symptoms, psychological distress, self-reported physician-diagnosed mental health conditions, or antidepressant use. This approach allowed the researchers to capture a broad spectrum of clinically relevant mental health concerns rather than focusing on a single diagnosis.
The analysis included more than 30,000 individuals at baseline and nearly 28,000 at follow-up, with a median follow-up period of just under three years. At baseline, nearly one in four participants were classified as being at high risk of OSA, a proportion that rose to more than one in four at follow-up. Poor mental health outcomes were also common, affecting over one-third of participants at baseline and nearly one-third at follow-up.
Key Findings:
- After accounting for potential confounding factors, participants at high risk of obstructive sleep apnea showed approximately 40% higher odds of poor mental health at both baseline and follow-up compared with those at lower risk.
- Longitudinal, repeated-measures analyses indicated that elevated OSA risk was consistently associated with a 44% increase in the likelihood of reporting mental health problems over time, pointing to a sustained and possibly progressive association.
The authors noted that these findings help clarify the temporal association between OSA risk and mental health during midlife and older age. By demonstrating that elevated OSA risk is linked not only to existing mental health conditions but also to newly reported problems over time, the study underscores the importance of recognizing sleep apnea as a factor in mental health assessment.
"Overall, the results highlight the need for more comprehensive screening and intervention strategies that address both sleep health and mental well-being, particularly in aging populations where these conditions are common and often underdiagnosed," the authors concluded.
Reference:
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 Netw Open. 2025;8(12):e2549137. doi:10.1001/jamanetworkopen.2025.49137
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