# The Risk of Obstructive Sleep Apnea Among Patients With Major Depressive Disorder and Generalized Anxiety Disorder in Saudi Arabia: A Cross-Sectional Study

## TL;DR

This study found that nearly 28% of Saudi patients with depression or anxiety are at high risk for obstructive sleep apnea, highlighting the need for sleep evaluations in psychiatric care.

## Contribution

The study is the first to assess OSA risk in psychiatric populations in Saudi Arabia, revealing high OSA risk and poor sleep quality in these patients.

## Key findings

- 27.9% of participants were at high risk for obstructive sleep apnea based on the STOP-BANG score.
- 73.2% of participants reported poor sleep quality according to the PSQI scale.
- Anxiety patients showed significantly higher daytime sleepiness compared to depression patients.

## Abstract

Introduction

Obstructive sleep apnea (OSA) is a common sleeping disorder characterized by recurring episodes of upper airway collapse during sleep. The relationship between OSA and psychiatric disorders, particularly depression and anxiety, has gained significant attention due to their frequent co-occurrence and bidirectional relationship. In this study, we assessed the risk of OSA among patients with psychiatric disorders and evaluated associated factors such as sleep quality and daytime sleepiness in the Saudi population.

Methods

This is a cross-sectional study that included patients with a confirmed diagnosis of major depressive and generalized anxiety disorders at King Abdulaziz Medical City in Jeddah, Saudi Arabia, from January 1 to December 31, 2023. Participants were interviewed in person and asked to fill out a survey that contains participants’ demographical data, validated Arabic versions of the Snoring, Tiredness, Observed apnea, high blood Pressure, BMI, Age, Neck circumference, Gender (STOP-BANG) questionnaire, Pittsburgh Sleep Quality Index (PSQI), Epworth Sleepiness Scale (ESS), Patient Health Questionnaire-9 (PHQ-9), and Generalized Anxiety Disorder-7 (GAD-7). Data was analyzed using appropriate statistical tests.

Results

A total of 183 patients diagnosed with major depressive disorder and/or generalized anxiety disorder were included. The study revealed that 27.9% (n=51) of participants were at high risk for OSA, scoring >3 on the STOP-BANG scale, with no significant difference between anxiety and depression diagnoses (p-value=0.737). Poor sleep quality was prevalent, with 73.2% (n=134) of participants scoring >5 on the PSQI scale. The median PSQI score was 8 (interquartile range (IQR)=5.00, 11.00), indicating poor overall sleep quality, with sleep latency, sleep efficiency, sleep disturbance, and daytime dysfunction components showing particular impairment. Anxiety patients demonstrated significantly higher daytime sleepiness compared to those with depression (p=0.041). In addition, we observed moderate to severe anxiety and depression in 26.8% (n=49) and 29% (n=53) of participants, respectively, highlighting a substantial psychiatric burden.

Conclusion

This study emphasizes the high prevalence of OSA risk and poor sleep quality among patients with psychiatric disorders. These findings underscore the need for comprehensive sleep evaluations in psychiatric populations and emphasize the importance of integrating sleep assessments into routine psychiatric care. Because of the complex bidirectional relationship between OSA and psychiatric disorders, tackling both conditions concurrently is crucial in clinical practice.