European Child & Adolescent Psychiatry

, Volume 28, Issue 5, pp 635–643 | Cite as

Sleep apnea may be associated with suicidal ideation in adolescents

  • Wen-Che Tseng
  • Yun-Chieh Liang
  • Mei-Hsin Su
  • Yun-Ling Chen
  • Hao-Jan Yang
  • Po-Hsiu KuoEmail author
Original Contribution


Suicide is a major threat to adolescent health. Sleep problems increase the risk of adolescent suicidal behavior, but the role of sleep-disordered breathing (e.g., sleep apnea) is unclear. We investigated whether sleep apnea had an effect on suicidal ideation that was independent of depression and perceived stress. We examined a series of sleep variables with suicidal ideation in 746 fifth and seventh graders using self-reported questionnaires to assess time in bed, sleep quality, insomnia, and sleep apnea while controlling depression and perceived stress. Overall, 8.8% of students aged 10–14 years reported having recent suicidal ideation, and 33% or 3.8%, depending on the screening criteria, reported having suspected sleep apnea. The sleep variables were all associated with an increased risk of suicidal ideation, but the magnitude of effects was largely attenuated when depression and perceived stress were included in the models. Suspected sleep apnea using daytime sleepiness as a screening criterion was independently associated with suicidal ideation (odds ratio = 2.25, p < 0.05). Suspected sleep apnea was associated with suicidal ideation that was partly independent of depression and stress, which reveals the pertinence of screening for sleep apnea among school students and designing proper prevention strategies for reducing youth suicidal behavior.


Sleep Adolescents Suicidal ideation Sleep apnea 



World Health Organization


Obstructive sleep apnea


Continuous positive airway pressure


Epworth’s Sleepiness Scale


Chinese version of the Pittsburg Sleep Quality Index


7-item modified Epworth’s Sleepiness Scale


Perceived Stress Scale


Center for Epidemiologic Studies Depression Scale


Cognitive behavioral therapy for insomnia



This study was supported by the Ministry of Science and Technology in Taiwan (MST101-2314-B-002-128-MY3 grant to Dr. P–H Kuo and NSC99-2511-S-040-004-MY3 grant to Dr. H-J Yang). We would like to especially thank all subjects who agree to participate in this study. We also thank JH Shen, PC Chu, SS Huang, and WH Chiu who assisted for data collection and data management.

Author contributions

WCT hypothesized to test the associations between sleep-disordered breathing and suicidal ideation, and wrote the first draft of the manuscript. YCL and YLC assisted in data cleaning and analyses. MHS assisted in data collection and designing the coding book. HJY and PHK were in charge of the study design and the acquisition of the financial support from the government. PHK also coordinated this study, assisted to explain statistical analysis results, and made critical revision of the manuscript.

Compliance with ethical standards

Conflict of interest

There is no conflict of interest in the present study.

Ethical standards

This study was approved by the Institutional Review Board of National Taiwan University Hospital. All procedures performed in the present study involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards, and all participants and one of their parents provided informed consent.


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of EpidemiologyHarvard T.H. Chan School of Public HealthBostonUSA
  2. 2.National Taiwan University HospitalTaipeiTaiwan
  3. 3.Clinical Trial CenterNational Taiwan University HospitalTaipeiTaiwan
  4. 4.Department of Public Health and Institute of Epidemiology and Preventive Medicine, College of Public HealthNational Taiwan UniversityTaipeiTaiwan
  5. 5.Department of Public HealthChung Shan Medical UniversityTaichungTaiwan
  6. 6.Research Center for Genes, Environment and Human HealthNational Taiwan UniversityTaipeiTaiwan

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