Can Sleep Apnea Increase the Risk of Suicide?

The national survey seems to indicate that those living with sleep apnea are at a higher risk of suicide. Because those affected by sleep apnea are more probable to idealize suicide, plan it, or see it as an option, this makes an early diagnosis of sleep apnea as an opportunity to prevent suicide and other related mental health conditions.

Sleep apnea is a common sleep disorder in the United States, and it is a condition where the upper respiratory airway becomes blocked several times while sleeping, resulting in respiratory disturbances and low oxygen perfusion. When it happens too often, the brain gets a signal and the person wakes up to correct these things voluntarily.

However, if this condition continues over an extended period of time, it results in an altered biorhythm, the altered functioning of the brain and autonomic nervous system, and the dominance of sympathetic system. All of this is because of the patient's worsening health and unnecessary stress. With this phenomenon, mental health is not left untouched. Poor sleep quality leads to mood swings, irritation, and depression.

Continuous positive air pressure (CPAP), which is providing air under pressure through a mask while the patient is sleeping, has shown to be an excellent way of reducing the harm from this condition. Whereas, surgical correction of anatomical deviations remains one of the most effective of the remedies.

There seems to be a clear link between the quality of sleep, mood disorders, and age. As people grow older, the prevalence of sleep apnea increases (found in more than 50% of cases), sleep quality worsens, and mood disorders become common. Suicidal thoughts are among some of the prominent symptoms of depression and similar mood disorders.

Most of the large and small epidemiological studies have consistently supported the high level of association between depression and obstructive sleep apnea. So, in a large-scale cross-sectional study, 18,980 participants were analyzed for this connection. The study demonstrated that in those living with depression, sleep apnea was five times more common as compared to the healthy population.

Similarly, analysis of another study called the Veterans Health Administration Beneficiary (from 1998 to 2001), apparently showed that the prevalence of mood disorders including depression and suicidal thoughts were much more common in those with sleep apnea. The study showed that obstructive sleep apnea increased the risk of developing depression by two-fold in those with mild sleep apnea, and 2.6-fold in those with moderate sleep apnea.

Initially, there has been lots of controversy about whether it is depression that causes sleep apnea, or if it is sleep apnea that leads to depression. However, now sleep apnea has been recognized as the independent risk factor for depression. By having an early diagnosis of sleep apnea, it would prevent the development of depression and related conditions later in life. Moreover, timely treatment of sleep apnea would improve a patient's mood.

A number of earlier studies have noticeably indicated that sleep quality has a lot to do with changes in someone's mood. If these mood changes remain unchecked, they may, in theory, aggravate the condition leading to grave consequences, like the thoughts of suicide, its idealization, and if untreated, it may even lead to suicide itself.

So what insight does the latest study bring into the subject?

Results of this latest finding were discussed at the annual meet of the American Society of Clinical Psychopharmacology. The researchers said that although they were long aware of the link between suicidal thoughts and sleep disturbances or insomnia, they were not sure of how much sleep apnea can influence the suicidal thought pattern and behavior.

Thus, what the investigators did is to analyze the 2014 data of National Survey on Drug Use and Health. It was the data from more than 40,000 households in the US that were chosen randomly. In this research, people were interviewed regarding suicidal thoughts, its idealization, planning or even attempting suicide. At the same time, they were given questions regarding the quality of sleep, they were assessed for the presence of sleep apnea.

So, what did the research indicate?

At the end of the analysis, researchers found that sleep apnea was present in 2.9% or 1,155 individuals. Prevalence of suicidal thoughts among such individuals was quite high, with 9.7% accepting that they idealize the suicide, while 3.4% even reported planning it, and around 1% went on to attempt suicide. That was much higher in comparison to those who did not report symptoms of sleep apnea, with suicide idealization at 4.9%, planning at 1.4%, and attempts at 0.7%.

Data clearly indicated that the risk of suicide was almost twice as high in those with self-reported symptoms of sleep apnea. Though that would undoubtedly be an over exaggeration of the facts, because this threat came down when investigators started to consider the presence of other risk factors for suicide like age, gender, substance abuse, ethnicity, self-reported overall health, misuse of hypnotics or sedative drugs, heart disease, stroke, high blood pressure, episodes of major depression, and body mass index. After considering all the factors, they found that sleep apnea was still a risk factor for suicide, but only a minor risk factor.

The final report from the analysis, after considering all the factors that may play a role in suicidal thoughts and attempts, investigators concluded that obstructive sleep apnea increases the risk by somewhere around 1.22 times. It is a slight increase in risk, yet relevant for such a dangerous thought as suicide.

Thus, one may conclude that improving sleep quality has the potential to bring down the risk of suicides. It is undoubtedly just one of the small contributors to the cocktail of problems that forces people to start thinking about suicide as an option. But it is in no way something that could be neglected.

It would be difficult to say whether obstructive sleep apnea is an independent risk factor for suicide, but what can be stated with confidence is that it is undoubtedly one of the indicators. Thus, by taking care of your overall well-being, improving your sleep quality would lead to a better state of mood and decline in suicidal thoughts.

References

1. Schröder CM, O’Hara R. Depression and Obstructive Sleep Apnea (OSA). Ann Gen Psychiatry. 2005;4:13. doi:10.1186/1744-859X-4-13.
2. Kerner NA, Roose SP. Obstructive Sleep Apnea is Linked to Depression and Cognitive Impairment: Evidence and Potential Mechanisms. Am J Geriatr Psychiatry. 2016;24(6):496-508. doi:10.1016/j.jagp.2016.01.134.
3. Bishop TM, Ashrafioun L, Pigeon WR. The Association Between Sleep Apnea and Suicidal Thought and Behavior: An Analysis of National Survey Data. J Clin Psychiatry. 2017;79(1):0-0. doi:10.4088/JCP.17m11480.