Year: 2025
Type: article
Abstract: Obstructive sleep apnea (OSA)-a condition characterized by repeated upper airway narrowing during sleep, leading to sleep fragmentation, sympathetic activation, and intermittent hypoxemia-is prevalent yet underdiagnosed among adults.Despite being potentially treatable with costeffective, evidence-based treatments such as continuous positive airway pressure, OSA remains undertreated.Untreated OSA may contribute to the development and progression of cardiovascular diseases as well as dementia and mental health conditions, through hypoxemia and sleep fragmentation.Notably, simple validated questionnaires, such as the STOP (snoring, daytime somnolence, witnessed apnea during sleep, or hypertension) questionnaire, or a specific question on witnessed apnea can help in identifying adults at high vs low risk of OSA risk in the context of largescale community-based studies. 1 Indeed, Kendzerska and colleagues 1 investigated whether high risk of OSA-as assessed using the STOP questionnaire or the witnessed apnea question-was associated with increased odds of concurrent and future mental health conditions among more than 27 000 middle-aged and older participants of the Canadian Longitudinal Study on Aging.By conducting secondary analyses of the Canadian Longitudinal Study on Aging, Kendzerska and colleagues 1 showed that middle-aged and older adults at high risk of OSA had an approximately 40% higher odds of mental health conditions at both baseline and follow-up than those with low risk.Over a median follow-up of 2.9 years, high vs low risk remained associated with increased odds of reporting new mental health conditions.The associations of OSA with depression, anxiety, and reduced quality of life are discussed by the authors in line with recent literature.The study by Kendzerska and colleagues 1 is notable in several ways.First, it reinforces the need to consider OSA not only as a sleep or respiratory condition, but also as a potential driver of psychological and cognitive decline in later life.The pathways are likely multifactorial; intermittent hypoxia and sleep fragmentation can disrupt neuroendocrine, inflammatory, and circadian mechanisms that are central to mood and cognition regulation.This is especially relevant in aging populations, in which resilience may already be compromised by multiple morbidities and polypharmacy.At the same time, poor mental health can undermine the ability to care for one's own self, adhere to medications, and maintain healthy behaviors, thus worsening physical health outcomes.Despite this, mental health and physical health often continue to be assessed and treated in parallel rather than together.Second, this study underscores the value of embedding OSA risk assessment within longitudinal cohort studies.It provides clinical data that extend beyond traditional clinical trial populations, including many older adults with complex health profiles who are often underrepresented in controlled studies.Third, the findings underscore the need to rethink OSA management in clinical conversations.Traditionally, treatment is discussed in the context of snoring, fatigue, or daytime sleepiness; further research should explore whether patients who do not report severe symptoms may also benefit from OSA treatment in the long term in relation to mental health outcomes.Moreover, clinicians may more effectively motivate patients' engagement in OSA management if they promote this as a preventive strategy for brain, mood, and heart health.This study 1 also aligns with broader public health frameworks.OSA risk detection and management fits squarely within the World Health Organization (WHO) prevention-and-resilience framing for healthy aging: the "World report on ageing and health" 2 defines healthy aging as maintaining functional ability (ie, preserving intrinsic capacity or resilience) and advocates for service models that prioritize function rather than disease alone.In practice, the WHO's ICOPE (Integrated Care for Older People) handbook provides a low-threshold community or primary-care screening +
Source: JAMA Network Open
Language: English
Subfield: Physiology
Field: Medicine
Domain: Health Sciences
Open Access status: gold
Estimated APC paid: $3,000
OpenAlex ID: W7117293363