Suicidality in adults with obstructive sleep apnea: A systematic review and Meta-Analysis

To assess relations between obstructive sleep apnea (OSA) and suicidality, measured by suicidal ideation, suicide attempts, and death by suicide.

CINAHL, Cochrane Library, PubMed, PsycINFO and SCOPUS were searched from inception through June 24, 2024. Observational studies related to suicidality in adult OSA patients were included. Case reports and studies on central sleep apnea were excluded. Data were extracted and reviewed by two authors, with disagreements resolved by a third. Risk of bias was assessed with the Risk Of Bias In Non-randomized Studies - of Exposure for cohort studies and the Joanna Briggs Institute checklist for case-control and cross-sectional studies. Random effects meta-analyses (single means, proportions, and relative risks (RR)) were performed.

Fifteen studies (n = 1,438,523) were included: eight assessed suicidal ideation, two assessed suicide attempts, and six assessed death by suicide. The OSA group experienced a higher prevalence of suicidal ideation (12.4% [95% CI: 8.9%-16.3%] vs. 3.7% [95% CI: 1.9%-6.2%]), suicide attempts (1.5% [95% CI: 0.9%-2.2%] vs. 0.9% [95% CI: 0.1%-2.2%]), and death by suicide (0.3% [95% CI: 0.2%-0.4%] vs. 0.2% [95% CI: 0.1%-0.3%]) than controls (p < 0.001). The OSA group had a higher risk of suicidal ideation (RR = 1.8, 95% CI: 1.5-2.1) and death by suicide (RR = 1.9, 95% CI: 1.1-3.4) than the control group (p < 0.001).

Suicidal ideation affects nearly 12% of patients with OSA, with close to 2% attempting suicide. Otolaryngologists should consider the risk of suicidality in these patients.