2026 ECNP Congress

PS02-2254

Association of obstructive sleep apnea with body mass index, sleep duration, and depression outcomes in Korean adults

Saeheon Jang — Bongseng Memorial Hospital, Psychiatry, Busan, Korea- Rep

2026 ECNP Congress

Background

Obstructive Sleep Apnea (OSA) is a prevalent sleep disorder characterized by recurrent upper airway obstruction during sleep and is strongly associated with obesity and metabolic dysregulation. In addition to its cardiometabolic consequences, increasing evidence suggests a potential association between OSA and depression; however, findings remain inconsistent, particularly in population-based studies. Moreover, the relative contributions of sleep duration and OSA to body mass index (BMI) and depression outcomes remain unclear. This study aimed to evaluate the associations of OSA with BMI, sleep duration, and multiple depression-related outcomes in a nationally representative sample of Korean adults.

Methods

We conducted a cross-sectional analysis using data from the Korea National Health and Nutrition Examination Survey (KNHANES) collected between 2019 and 2023. The primary analysis included adults aged ≥18 years. Average weekday sleep duration was assessed using self-reported measures, and implausible responses were treated as missing. OSA status was defined as a binary variable indicating the presence or absence of OSA. Depression-related outcomes included physician-diagnosed depression, current depressive status, and depression treatment status. Pearson and Spearman correlation analyses were performed to assess the relationship between sleep duration and BMI. Differences in BMI according to OSA status were evaluated using Welch’s t-test, and associations between OSA and categorical depression outcomes were examined using chi-square and Fisher’s exact tests. A subgroup analysis restricted to individuals aged ≥40 years was subsequently conducted.

Results

In the overall population, the prevalence of OSA was approximately 0.7%. The mean BMI was 24.07 kg/m², and the mean weekday sleep duration was 6.73 hours. Sleep duration showed a statistically significant but weak negative correlation with BMI (Pearson r = −0.052, p < 0.001; Spearman ρ = −0.058, p < 0.001), indicating a negligible effect size.

Individuals with OSA had significantly higher BMI compared to those without OSA (mean difference = 1.70 kg/m², p < 0.001), whereas sleep duration did not differ significantly between groups.

No statistically significant associations were observed between OSA status and physician-diagnosed depression (odds ratio [OR] = 1.08, p = 0.79), current depressive status (OR = 2.13, p = 0.65), or depression treatment status (OR = 4.26, p = 0.31). However, consistent trends toward higher prevalence of current depression and treatment were observed among individuals with OSA. These findings were accompanied by wide confidence intervals, reflecting limited statistical power due to the small number of OSA cases.

In the subgroup aged ≥40 years, the overall pattern remained consistent, with weak associations between sleep duration and BMI and no significant associations between OSA and depression outcomes.

Conclusions

In this population-based study using KNHANES 2019–2023 data, OSA was associated with a clinically meaningful increase in BMI, whereas sleep duration showed only a negligible association. Although no significant relationship between OSA and depression outcomes was observed, consistent directional trends suggest a potential association that may have been underestimated due to limited statistical power and possible underdiagnosis of OSA. These findings were consistent in the ≥40-year subgroup. Future longitudinal studies incorporating objective sleep assessments are needed to clarify these relationships.

References

  1. Cappuccio, F. P., Taggart, F. M., Kandala, N.-B., Currie, A., Peile, E., Stranges, S., & Miller, M. A. (2008). Meta-analysis of short sleep duration and obesity in children and adults. Sleep, 31(5), 619–626. https://doi.org/10.1093/sleep/31.5.619
  2. Patel, S. R., Malhotra, A., White, D. P., Gottlieb, D. J., & Hu, F. B. (2006). Association between reduced sleep and weight gain in women. American Journal of Epidemiology, 164(10), 947–954. https://doi.org/10.1093/aje/kwj280
  3. Young, T., Peppard, P. E., & Gottlieb, D. J. (2002). Epidemiology of obstructive sleep apnea: A population health perspective. American Journal of Respiratory and Critical Care Medicine, 165(9), 1217–1239. https://doi.org/10.1164/rccm.2109080
  4. Senaratna, C. V., Perret, J. L., Lodge, C. J., Lowe, A. J., Campbell, B. E., Matheson, M. C., Hamilton, G. S., & Dharmage, S. C. (2017). Prevalence of obstructive sleep apnea in the general population: A systematic review. Sleep Medicine Reviews, 34, 70–81. https://doi.org/10.1016/j.smrv.2016.07.002
  5. Peppard, P. E., Young, T., Barnet, J. H., Palta, M., Hagen, E. W., & Hla, K. M. (2013). Increased prevalence of sleep-disordered breathing in adults. American Journal of Epidemiology, 177(9), 1006–1014. https://doi.org/10.1093/aje/kws342