Loud snoring, fatigue upon waking up, fatigue during the day… In those over 45, these signs ofsleep apnea Worry especially for the heart or blood pressure. A large Canadian study shows that they could also weigh heavily on morale and the mind.
Carried out on more than 30,000 adults aged 45 to 85 followed for nearly three years, this research published in JAMA Network Open
clearly connects obstructive sleep apnea and degradation of the
mental health (depression, anxiety, psychological distress). And the figures are far from anecdotal.
After 45 years, increased risk of mental disorders
The data of Canadian Longitudinal Study on Aging
involve 30,097 participants at inclusion and 27,765 at follow-up, with a median follow-up of 2.9 years. The risk of sleep apnea syndrome was assessed by the STOP questionnaire (snoring, daytime sleepiness, observed apnea, hypertension). At baseline, almost a quarter of participants (23.5%) were considered at high risk for obstructive sleep apnea (OSA), a proportion which increased to 27.0% at follow-up. Sleep apnea observed during sleep was reported by 14.1% of participants at baseline and by 16.8% at follow-up. Poor mental health was common, affecting 34.3% of participants at baseline and 31.9% at follow-up.
“To assess the consequences on mental health, our team used a composite definition of “poor mental health”. It took into account the presence of at least one of the following indicators: a high score on an abbreviated depression scale, a high score on a psychological distress scale, a self-reported medical diagnosis or self-reported antidepressant use. We also looked separately at physician-diagnosed anxiety disorders, mood disorders, and clinical depression.”explained Tetyana Kendzerska, senior researcher at The Brighter Side of News.
After adjusting for many factors (age, lifestyle, chronic diseases), being at high risk of sleep apnea was linked to approximately 40% more risk to present mental disorders, at inclusion and at follow-up. In nearly 20,000 people without psychological problems at baseline, the high risk of sleep apnea increased the probability of developing a mental disorder within three years by 20%. Repeated measures analyses, accounting for changes over time, reinforced these findings, showing a 44% increased likelihood of poor mental health associated with elevated risk of sleep apnea syndrome.
Particularly vulnerable profiles, including in France
In the subgroup already at high risk for OSA but without an initial mental disorder, 11.2% developed a mental health problem at follow-up. The factors associated with this shift were female gender, modest income, low life satisfaction, poor perceived health, but also other sleep disorders (restless legs, insomnia, etc.) and pain. The authors emphasize that OSA appears to be a modifiable risk factor, therefore a potential target to protect mental health.
In France, sleep apnea affects between 4 and 10% of the population. For Géraldine Rauchs, research director at Inserm in Caen, “When you have sleep apnea, there is a decrease in oxygen saturation, your organs are less supplied with oxygen“, she explained to France Bleu. “You therefore have broken sleep, which is not continuous, which is not restorative. We know that sleep fragmentation is closely linked to mood disorders. This will therefore create brain damage in regions that are potentially important for the regulation of emotions, mental health, etc..”. This mechanism could also promote inflammation mechanisms linked to many pathologies and weaken vascular health.
Treat apnea to also protect morale
The authors summarize their findings as follows: “These findings fill knowledge gaps on the association between obstructive sleep apnea and mental health during aging, highlighting the need for integrated screening and intervention strategies,” the authors concluded in JAMA Network Open.
According to Géraldine Rauchs, OSA is “a pathology that we know how to treat using masks that we place on the face and which send oxygen“. This very effective positive pressure treatment becomes doubly relevant if we can now say that it also reduces the risk of depression. A recent study has even linked OSA to a greater risk of developing Alzheimer’s disease.
In those over 45, the symptoms of snoring, breathing pauses and drowsiness therefore deserve to be reported to the doctor, especially if they are accompanied by reduced morale or persistent anxiety.