Journal of Shandong University (Health Sciences) ›› 2026, Vol. 64 ›› Issue (1): 19-27.doi: 10.6040/j.issn.1671-7554.0.2024.0919

• Special Issue—Mechanistic Evidence and Clinical Translation in Mental and Sleep Disorders • Previous Articles     Next Articles

Association of excessive daytime sleepiness severity with anxiety and depressive symptoms in obstructive sleep apnea patients: a large-scale clinical study

FENG Yani, NIU Xiaoxin, MA Lina, SHI Yewen, SU Yonglong, XIE Yushan, YUAN Yuqi, ZHU Simin, ZHOU Yanuo, LIU Haoyu, LIU Haiqin, REN Xiaoyong   

  1. Department of Otorhinolaryngology &
    Head and Neck Surgery, The Second Affiliated Hospital of Xian Jiaotong University, Xian 710004, Shaanxi, China
  • Published:2026-01-27

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Abstract: Objective To investigate the association between excessive daytime sleepiness(EDS)severity and anxiety/depression symptoms in obstructive sleep apnea(OSA)patients, and to evaluate the clinical value of EDS stratification in psychiatric risk assessment. Methods A total of 1,185 OSA patients diagnosed by polysomnography(PSG)at the Sleep Medicine Center of the Second Affiliated Hospital of Xian Jiaotong University(January 2022-December 2024)were enrolled. Participants were categorized using the Epworth Sleepiness Scale(ESS)into non-EDS and EDS groups. Psychological symptoms were assessed using the Self-Rating Anxiety Scale(SAS)and Self-Rating Depression Scale(SDS). Statistical analyses included χ2 test, Fishers exact test, Mann-Whitney U test, Pearson correlation, and multivariate logistic regression to examine relationships between EDS levels, PSG parameters, and psychiatric symptoms. Results The EDS group(n=498)showed significantly higher prevalence rates of depression(36.35% vs 27.94%, P<0.01)and anxiety(17.07% vs 8.15%, P<0.01)compared to non-EDS group(n=687). A dose-dependent relationship was observed: depression prevalence increased from 26.79%(mild), 39.45%(moderate)to 54.03%(severe EDS); anxiety rates progressed from 12.45% to 21.10% and 23.39% respectively. Multivariate regression analysis revealed that moderate EDS(OR=1.894, 95%CI: 1.170-3.067)and severe EDS(OR=3.184, 95%CI: 1.974-5.137)significantly increased depressive symptom risk. Similarly, anxiety risk increased with EDS severity(moderate: OR=2.032, 95%CI: 1.114-3.705; severe: OR=2.435, 95%CI: 1.340-4.425). Conclusion EDS severity independently predicts anxiety and depression risks in OSA patients, demonstrating clinically significant dose-response effects. Stratified EDS assessment should be incorporated into personalized therapeutic strategies for comprehensive OSA management.

Key words: Obstructive sleep apnea, Excessive daytime sleepiness, Psychiatric complications, Anxiety, Depressed

CLC Number: 

  • R766.7
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