Does Sleep Apnea Cause Anxiety? (Research Review)

Research suggests that there’s a correlation between sleep apnea and anxiety.

And since sleep apnea is a condition caused by physical abnormalities typically caused by weight gain, there’s no obvious way for anxiety to induce apnea.

That means that if there is a link between apnea and anxiety, the sleep apnea is almost certainly causing the anxiety.

Let’s take a quick look at that research to try and find a clear answer.

Does Sleep Apnea Cause Anxiety?

Current research does show that sleep apnea causes anxiety. However, it’s not clear whether or not the severity of anxiety is tied to the severity of sleep apnea.

A systematic review looked at the results of 73 published articles on sleep apnea patients (1).

They found that:

35% of OSA patients had depressive symptoms, while 32% had anxiety symptoms

So it’s not like every single OSA patient develops significant anxiety, but it is fairly common.

How Does Sleep Apnea Cause Anxiety?

It doesn’t appear that anxiety is a side effect of the physical apnea symptoms.

While sleep apnea can cause symptoms like high blood pressure, it’s only weakly related to anxiety (2).

The more likely reason that sleep apnea causes anxiety is the obvious one:

The symptoms of apnea causes unease about sleep quality, which then causes anxiety directly

Not everyone is as concerned about their sleep quality (i.e. total sleep time, waking up after an apnea, etc.), so it does align with the fact that anxiety is common but not guaranteed in sleep apnea patients.

How Does the Severity of Sleep Apnea Affect Anxiety?

It’s natural to think that more severe sleep apnea symptoms will cause more severe anxiety, but current research doesn’t clearly show that link.

Studies have found that patients with the most severe obstructive sleep apnea are most likely to have anxiety (3)

According to polysomnographic results, we found that the majority of patients suffering from anxiety (66.7%) had severe OSAS

However, other research has found no correlation between sleep apnea symptoms and the severity of anxiety (4).

SummaryIn other words, this suggests that severe sleep apnea puts someone at high risk of developing anxiety symptoms. But the severity of these anxiety symptoms are more related to individual factors like overall mental health.

Does CPAP Treatment Improve Anxiety?

The standard treatment to treat apneas is continuous positive airway pressure (CPAP).

While this does typically reduce or eliminate apnea episodes, it’s unclear if CPAP improves anxiety side effects.

A 2007 review found (5):

The effect of the continuous positive airway pressure (CPAP) on mood was inconsistent.

In the review, anxiety was included under “mood.”

This might suggest that the anxiety from sleep apnea isn’t primarily from the apnea episodes, but other symptoms. More research will need to be done on this area.

Sleep Apnea Increases the Risk of Panic Attacks

Finally, I think it’s also relevant to note that some research has been done on sleep apnea and panic attacks, which are related to anxiety disorders.

A Taiwanese study found that sleep apnea patients were 2.17 times more likely to develop a panic disorder than the general population (6).

Summary: Sleep Apnea and Anxiety Disorders

There’s still a few gaps in the research, but it does seem pretty clear that sleep apnea often leads to developing anxiety.

It’s also unclear if CPAP will relieve anxiety symptoms, which makes treating the underlying cause of sleep apnea (typically being overweight) even more important.

Still, if someone has sleep apnea and has developed clear anxiety symptoms, they should consult their doctor to figure out the best next steps.

References

1. Association of Anxiety and Depression in Obstructive Sleep Apnea Patients: A Systematic Review and Meta-Analysis
2. Anxiety But Not Depression Is Associated With Elevated Blood Pressure in a Community Group of French Elderly
3. The correlation of anxiety and depression with obstructive sleep apnea syndrome
4. Severity of depression and anxiety in obstructive sleep apnea syndrome
5. Depression and anxiety in obstructive sleep apnea syndrome: a review
6. Sleep Apnea and Risk of Panic Disorder