Before blaming daytime fatigue on the illness or the medication, check the airway
STUDY: Sommerhoff C et al, Acta Psychiatrica Scandinavica 2026
STUDY TYPE: Systematic review and meta-analysis
FUNDING: Spanish Ministry of Science, Instituto de Salud Carlos III, La Marató-TV3 Foundation, and European Union Horizon 2020
Background
People with serious mental illness die 15 to 25 years early, mostly from cardiovascular and respiratory disease. Obstructive sleep apnea feeds those risks, and its symptoms (fatigue, poor sleep, irritability, low mood) overlap with psychiatric illness.
The Study
- 47 studies of 10,494 people with schizophrenia, bipolar disorder, or major depressive disorder.
- Sleep apnea was confirmed by overnight sleep study or estimated by screening questionnaires.
- Most studies came from psychiatric clinics or sleep-referral centers.
Results
Sleep studies found apnea in 41% of patients overall:
- Schizophrenia: 38%
- Major depressive disorder: 38%
- Bipolar disorder: 36%
Other recent papers arrived at similar rates in child (44%) and adult (20-30%) ADHD, and even higher for PTSD (43-76%). In the case of PTSD, we see sleep apnea even in young, thin patients.
Two studies that compared with healthy controls found psychiatric patients had about 7 times the odds of sleep apnea. Rates rose with age, but body weight did not explain differences between studies.
Limitations
- Sleep-referral samples likely inflate the prevalence.
- Only two studies compared patients with healthy controls.
- A third of studies were low quality.
Practice Implications
- Screen regularly with the free STOP-Bang questionnaire; refer for sleep apnea testing when the score is 3 or higher.
- Neck circumference may be a better sign than weight or symptoms in psychiatric patients.
—Chris Aiken, MD
Director, Psych Partners
Editor in Chief, Carlat Psychiatry Report
