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Sleep apnea may be associated with suicidal ideation in adolescents

European Child & Adolescent Psychiatry volume 28, pages 635–643 (2019)Cite this article

Abstract

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.

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Abbreviations

WHO:

World Health Organization

OSA:

Obstructive sleep apnea

CPAP:

Continuous positive airway pressure

ESS:

Epworth’s Sleepiness Scale

CPSQI:

Chinese version of the Pittsburg Sleep Quality Index

ESS-7:

7-item modified Epworth’s Sleepiness Scale

PSS:

Perceived Stress Scale

CES-D:

Center for Epidemiologic Studies Depression Scale

CBT-I:

Cognitive behavioral therapy for insomnia

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Acknowledgements

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 information

Authors and Affiliations

  1. Department of Epidemiology, Harvard T.H. Chan School of Public Health, 677 Huntington Ave, Boston, MA, 02215, USA

    Wen-Che Tseng

  2. National Taiwan University Hospital, 7, Zhongshan S. Rd., Taipei, Taiwan

    Wen-Che Tseng

  3. Clinical Trial Center, National Taiwan University Hospital, 7, Zhongshan S. Rd., Taipei, Taiwan

    Yun-Chieh Liang

  4. Department of Public Health and Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, 17, Xuzhou Rd., Taipei, Taiwan

    Mei-Hsin Su, Yun-Ling Chen & Po-Hsiu Kuo

  5. Department of Public Health, Chung Shan Medical University, 110, sec.1, Jianhuo N. Rd., Taichung, Taiwan

    Hao-Jan Yang

  6. Research Center for Genes, Environment and Human Health, National Taiwan University, 2, Xuzhou Rd., Taipei, Taiwan

    Po-Hsiu Kuo

Authors
  1. Wen-Che Tseng
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  2. Yun-Chieh Liang
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  3. Mei-Hsin Su
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  4. Yun-Ling Chen
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  6. Po-Hsiu Kuo
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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.

Corresponding author

Correspondence to Po-Hsiu Kuo.

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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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Implications and contribution

We investigated the associations between suspected sleep apnea, several sleep variables, and suicidality among adolescents, and found that students with suspected sleep apnea were more likely to have suicidal ideation independent of depression or stress. The results revealed the need to screen for sleep apnea in addition to other sleep problems, in the hope of preventing youth suicide.

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Tseng, WC., Liang, YC., Su, MH. et al. Sleep apnea may be associated with suicidal ideation in adolescents. Eur Child Adolesc Psychiatry 28, 635–643 (2019). https://doi.org/10.1007/s00787-018-1227-8

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  • DOI: https://doi.org/10.1007/s00787-018-1227-8

Keywords

  • Sleep
  • Adolescents
  • Suicidal ideation
  • Sleep apnea