2026 ECNP Congress

PS03-3137

Prevalence of bidirectional comorbidity between obstructive sleep apnea and mood disorders: a systematic review and meta-analysis

Buket Yeşiloğlu — Ü.H. Yeşilkaya, D. Bengi, M. Şen, C. Meriç Özgündüz, B. Aksoy, Y. Peker, D. Ceylan · Koç University- Graduate School of Health Sciences, Department of Neuroscience, Istanbul, Türkiye

2026 ECNP Congress

Mood disorders, major depressive disorder (MDD) and bipolar disorder (BD), and obstructive sleep apnea (OSA) are highly prevalent conditions associated with high individual and societal burden. Recent evidence suggests shared pathophysiological mechanisms, including neurobiological dysregulation, sleep fragmentation, and inflammatory processes, as well as a bidirectional relationship influencing symptom severity, functional impairment, and treatment outcomes [1, 2, 3]. Despite growing interest, estimates of comorbidity vary across studies, and the factors contributing to this variability remain poorly understood. This study aimed to estimate the prevalence of comorbidity between OSA and mood disorders and to identify demographic, clinical, and methodological moderators.

This systematic review was registered in PROSPERO (CRD42023445215) and conducted in accordance with PRISMA guidelines. A comprehensive search of EMBASE, Ovid MEDLINE, Global Health, and APA PsycINFO was performed for studies published between January 1, 2013 and July 25, 2025. Observational studies including adults diagnosed with mood disorders using DSM or ICD criteria and OSA assessed with objective diagnostic methods were included. Two reviewers independently conducted screening, full-text assessment, and data extraction, with conflicts resolved by a third reviewer. Study quality was evaluated using a modified Newcastle–Ottawa Scale (NOS). Random-effects meta-analyses using restricted maximum likelihood estimation were conducted in R (metafor package). Subgroup analyses examined diagnostic subtype and assessment methods, and meta-regression analyses evaluated the influence of mean age, sex distribution, body mass index (BMI), apnea–hypopnea index (AHI), and study quality (NOS) on prevalence estimates.

Among 6,221 articles, 23 studies met inclusion criteria, comprising 2,380,986 individuals with OSA and 5,724 individuals with mood disorders. Among individuals with OSA, 446,495 had comorbid mood disorders. The pooled prevalence of mood disorders in OSA populations was approximately 10% (95% CI: 0.19 — 0.20), with high heterogeneity (I² = 99.9%). Subgroup analyses indicated higher prevalence for MDD (17% [95% CI: 0.09 — 0.30]) compared to BD (1% [95% CI: 0.00 — 0.03]), and higher estimates in studies using DSM/SCID interviews (25% [95% CI: 0.06 — 0.65]).

Among individuals with mood disorders, 450 cases of comorbid OSA were identified. The pooled prevalence of OSA in mood disorder populations was 19% ([95% CI: 0.09—0.36], I² = 98.3%). Subgroup analyses showed higher prevalence in MDD (24% [95% CI: 0.16 — 0.36]) compared to BD (11% [95% CI: 0.01 — 0.64]). Heterogeneity remained consistently high across all analyses. Meta-regression analyses did not identify significant moderators for mood disorder prevalence in OSA populations. However, higher mean age was associated with increased OSA prevalence in mood disorder populations, whereas higher BMI was associated with lower prevalence estimates. No significant associations were observed for sex distribution, AHI, or NOS.

These findings indicate a substantial and highly heterogeneous prevalence of comorbidity between OSA and mood disorders, particularly MDD. The identification of age and BMI as significant moderators highlights the importance of considering demographic and clinical characteristics in both research and clinical practice. These results support the need for systematic screening and integrated clinical approaches targeting both conditions. Further longitudinal studies using standardized diagnostic methods are required to clarify underlying mechanisms and reduce heterogeneity across studies.

References

  1. Benca, R. M., Krystal, A., Chepke, C., Doghramji, K., 2023. Recognition and management of obstructive sleep apnea in psychiatric practice. The Journal of clinical psychiatry 84(2), 22r14521-22r14521.
  2. Vanek, J., Prasko, J., Genzor, S., Ociskova, M., Kantor, K., Holubova, M., Slepecky, M., Nesnidal, V., Kolek, A., Sova, M., 2020. Obstructive sleep apnea, depression and cognitive impairment. Sleep medicine, 72, 50-58.
  3. Franzen, P.L., Buysse, D.J., 2008. Sleep disturbances and depression: risk relationships for subsequent depression and therapeutic implications. Dialogues Clin Neuroscience 10(4), 473–481.