Is It OSA or Depression or Both?

  • Ali M. Hashmi
  • Imran S. Khawaja
  • Wolfgang Schmidt-NowaraEmail author


Obstructive sleep apnea (OSA) and depression are common illnesses that frequently coexist in the same patient. Both can also be associated with several chronic, severe medical conditions including diabetes and cardiovascular disease. The symptoms of OSA and depression often overlap leading to frequent underdiagnosis of OSA patients who present to psychiatric clinics with symptoms of depression. Undiagnosed OSA in patients with depression can lead to poor outcomes and treatment failures. Clinicians need to be aware of the relationship between these two conditions since increased diagnostic accuracy can produce better outcomes for both conditions.


Sleep OSA Depression Apnea 


  1. 1.
    American Sleep Assoc. (2018). Sleep Statistics – Research & Treatments | American Sleep Assoc. [online] Available at: Accessed 8 Apr 2018.
  2. 2.
    Mosko S, Zetin M, Glen S, Garber D, DeAntonio M, Sassin J, McAnich J, Warren S. Self-reported depressive symptomatology, mood ratings, and treatment outcome in sleep disorders patients. J Clin Psychol. 1989;45(1):51–60.<51::aid-jclp2270450107>;2-h.CrossRefGoogle Scholar
  3. 3.
    Khawaja IS, Kazaglis L, Hashmi A, Khurshid KA, Eiken C, Hurwitz TD. Obstructive sleep apnea and depression: a review. Psychiatr Ann. 2016;46(3):187–91. Scholar
  4. 4.
    BaHammam AS, Kendzerska T, Gupta R, Ramasubramanian C, Neubauer DN, Narasimhan M, Pandi-Perumal SR, Moscovitch A. Comorbid depression in obstructive sleep apnea: an under-recognized association. Sleep Breath. 2016;20(2):447–56. Scholar
  5. 5.
    Chen Y, Keller J, Kang J, Hsieh H Lin H. Obstructive sleep apnea and the subsequent risk of depressive disorder: a population-based follow-up study. J Clin Sleep Med. 2013.
  6. 6.
    Kasasbeh E, Chi D, Krishnaswamy G. Inflammatory aspects of sleep apnea and their cardiovascular consequences. South Med J. 2006;99(1):58–67. Scholar
  7. 7.
    Irwin M, Miller A. Depressive disorders and immunity: 20 years of progress and discovery. Brain Behav Immun. 2007;21(4):374–83. Scholar
  8. 8.
    Somers VK, White DP, Amin R, Abrahan WT, Costa F, Culebras A, Daniels S, Floras JS, Hunt CE, Olson LJ, Pickering TG, Russell R, Woo M, Young T. Sleep apnea and cardiovascular disease: an American Heart Association/American College of Cardiology Foundation Scientific Statement from the American Heart Association Council for High Blood Pressure Research Professional Education Committee, Council on Clinical Cardiology, Stroke Council, and Council on Cardiovascular Nursing. J Am Coll Cardiol. 2008;52:686–717. Scholar
  9. 9.
    Moulton CD, Pickup JC, Ismail K. The link between depression and diabetes: the search for shared mechanisms. Lancet Diabetes Endocrinol. 2015;3(6):461–71. Scholar
  10. 10.
    Tantrakul V, Numthavaj P, Guilleminault C, McEvoy M, Panburana P, Khaing W, Attia J, Thakkinstian A. Performance of screening questionnaires for obstructive sleep apnea during pregnancy: a systematic review and meta-analysis. Sleep Med Rev. 2017;36:96–106. Scholar
  11. 11.
    Barnes M, Houston D, Worsnop CJ, Neill AM, Mykytyn IJ, Kay A, et al. A randomized controlled trial of continuous positive airway pressure in mild obstructive sleep apnea. Am J Respir Crit Care Med. 2002;165(6):773–80. Scholar
  12. 12.
    Rosenberg RS. Depression in the sleep center: are we treating the whole patient? Sleep Med. 2003;4(4):269. Scholar
  13. 13.
    Ejaz SM, Khawaja IS, Bhatia S, Hurwitz TD. Obstructive sleep apnea and depression: a review. Innov Clin Neurosci. 2011;8(8):17.PubMedPubMedCentralGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  • Ali M. Hashmi
    • 1
  • Imran S. Khawaja
    • 2
  • Wolfgang Schmidt-Nowara
    • 3
    Email author
  1. 1.Department of Psychiatry and Behavioral SciencesKing Edward Medical UniversityLahorePakistan
  2. 2.Center for Sleep Medicine, VA North Texas Health Care SystemDepartment of Psychiatry and Neurology and Neurotherapeutics, UT Southwestern Medical CenterDallasUSA
  3. 3.Department of Neurology and Sleep DisordersDallas VA Medical CenterDallasUSA

Personalised recommendations