The association between obstructive sleep apnea and symptoms of anxiety and depression: An 8-year follow-up using...

The interplay between obstructive sleep apnea (OSA) and psychiatric disturbances has gained increasing attention in Sleep Medicine. This study investigated the relationship of OSA with symptoms of anxiety and depression, as well as changes in these symptoms from baseline to the 8-year follow-up. Data were derived from the São Paulo Epidemiologic Sleep Study (EPISONO), a longitudinal population-based cohort with baseline assessment conducted in 2007 (N = 1042) and follow-up in 2015 (N = 712). OSA diagnosis was defined by the apnea-hypopnea index (AHI) obtained through full-night polysomnography, and OSA severity was classified according to American Academy of Sleep Medicine criteria. Anxiety and depressive symptoms were assessed using the Beck Anxiety Inventory (BAI) and Beck Depression Inventory (BDI-I in 2007 and BDI-II in 2015). Paired analyses using Wilcoxon signed-rank tests indicated that anxiety symptoms increased significantly between baseline and the 8-year follow-up in participants with OSA (p = 0.035). No change was observed in those without OSA (p = 0.110). Depressive symptoms did not change significantly in either group over the course of the assessments. In multiple linear regression models restricted to participants with OSA (n = 347), OSA severity was inversely correlated with anxiety symptoms (β = -0.14, p = 0.014) and depressive symptoms (β = -0.13, p = 0.023) after adjustment for demographic and anthropometric covariates. Within the OSA group, male sex was independently associated with lower anxiety (β = -0.24, p = 0.003) and depressive symptom levels (β = -0.273, p < 0.001). This longitudinal study showed increased anxiety over time in individuals with OSA, while depressive symptoms remained stable. Emotional symptoms were inversely correlated with OSA severity, suggesting influences beyond respiratory disturbance severity.