# Lack of Exercise is Associated With Psychological Distress in Patients With Obstructive Sleep Apnea Syndrome

## TL;DR

Not exercising is linked to worse mental health in people with sleep apnea, even when they use CPAP therapy.

## Contribution

This study identifies exercise habits as a key factor in psychological distress among OSAS patients on CPAP.

## Key findings

- 12.7% of OSAS patients on CPAP experienced psychological distress.
- Lack of exercise and higher daytime sleepiness were strongly linked to mental distress.
- Men had lower odds of distress compared to women.

## Abstract

Background and objective

Obstructive sleep apnea syndrome (OSAS) is linked not only to cardiometabolic disorders but also to psychological distress such as depression and anxiety. Although continuous positive airway pressure (CPAP) and regular exercise have been shown to improve psychological well-being, the specific contribution of exercise habits to mental health in OSAS patients, particularly those receiving CPAP therapy, remains unclear. This study aimed to identify clinical and lifestyle-related factors associated with psychological distress in patients with OSAS, focusing particularly on exercise habits.

Methods

We conducted a cross-sectional analysis of 1,204 OSAS patients receiving CPAP therapy. Psychological distress was assessed using the six-item Kessler scale (K6), and a cutoff score of ≥5 was used to define the distress group. Daytime sleepiness was measured using the Japanese version of the Epworth Sleepiness Scale (JESS). Logistic regression was performed to identify predictors of psychological distress, with sex, age, BMI, apnea-hypopnea index (AHI), JESS score, and exercise habit included as independent variables.

Results

Among the participants, 153 (12.7%) were classified as experiencing psychological distress. Logistic regression revealed that higher JESS scores (odds ratio (OR) = 1.12, 95% confidence interval (CI): 1.08-1.16, p < 0.001) and absence of exercise habits (OR = 0.48, 95% CI: 0.32-0.72, p < 0.001) were significantly associated with psychological distress. Male sex was associated with lower odds of distress (OR = 0.61, 95% CI: 0.38-0.96, p = 0.032). No significant associations were observed for age, BMI, or AHI.

Conclusions

Lack of regular exercise and increased daytime sleepiness were independently associated with psychological distress in OSAS patients. These findings highlight the importance of exercise promotion and sleep management in addressing mental health in this population. Physical therapists may play a vital role in implementing lifestyle interventions to improve both physical and psychological well-being among individuals with OSAS.