From the Guidelines
Anxiety does not directly cause sleep apnea, though the two conditions can coexist and influence each other. Sleep apnea is primarily a physical disorder where breathing repeatedly stops and starts during sleep due to airway obstruction or improper brain signaling to breathing muscles. The main causes include obesity, anatomical features like enlarged tonsils or a small jaw, smoking, alcohol use, and certain medical conditions. While anxiety can worsen sleep quality and may exacerbate symptoms of existing sleep apnea through increased muscle tension and disrupted sleep patterns, it is not a root cause of the condition. Some key points to consider in the diagnosis and management of sleep apnea include:
- The use of home sleep apnea testing (HSAT) for diagnosis, with a manually scored type III HSAT and an event index of 15 events per hour or higher indicating moderate to severe OSA 1.
- The importance of positive airway pressure (PAP) therapy for treatment of OSA, with continued use even in patients using it for less than 4 hours per night and supportive interventions to improve adherence 1.
- The potential for certain medications, such as opioids or sedative hypnotics, to worsen OSA and the need for caution or avoidance if possible 1. Conversely, sleep apnea can trigger or worsen anxiety due to poor sleep quality and repeated awakenings. If you're experiencing symptoms like loud snoring, gasping for air during sleep, excessive daytime sleepiness, or morning headaches, it's essential to consult a healthcare provider for proper diagnosis and treatment of sleep apnea.
From the Research
Relationship Between Anxiety and Sleep Apnea
- The relationship between anxiety and sleep apnea is complex, and research suggests that anxiety may not directly cause sleep apnea 2.
- A study published in 2010 found that the severity of obstructive sleep apnea (OSA) was not correlated with anxiety symptoms, as measured by the Beck Anxiety Inventory (BAI) 2.
- However, another study published in 2023 found that symptoms of anxiety were present in 14.4% of patients with OSA, and that severe OSA was less likely to be associated with anxiety symptoms 3.
Mechanisms and Associations
- The mechanisms underlying the relationship between anxiety and sleep apnea are not fully understood, but it is thought that factors such as sleep fragmentation, hypoxia, and hypercapnia may contribute to the development of anxiety symptoms in patients with OSA 3.
- A study published in 2012 found that portable sleep studies and positive airway pressure autotitration were effective in diagnosing and treating OSA, but did not specifically examine the relationship between anxiety and sleep apnea 4.
- Another study published in 2020 discussed the importance of polysomnography (PSG) in diagnosing sleep disorders, including OSA, but did not address the relationship between anxiety and sleep apnea 5.
Key Findings
- The current evidence suggests that anxiety may not be a direct cause of sleep apnea, but rather a comorbid condition that can occur in patients with OSA 2, 3.
- Further research is needed to fully understand the relationship between anxiety and sleep apnea, and to develop effective treatments for patients with both conditions 3.