Comorbid insomnia and sleep apnea as a potential predictor of suicide and self-harm. Commentary on Udholm et al. Obstructive sleep apnea and risk of suicide and self-harm: a Danish Nationwide Cohort Study.

Abstract

Insomnia and obstructive sleep apnea (OSA) are the two most common sleep disorders and frequently co-occur. Comorbid insomnia and sleep apnea (COMISA) is a highly prevalent condition that is associated with worse morbidity compared to insomnia-alone or sleep apnea-alone [1]. Indeed, up to 50% of people with OSA report co-occurring insomnia symptoms, including difficulties initiating sleep, maintaining sleep, and/or early morning awakenings from sleep, with associated daytime impairment [1]. People with COMISA also have increased depression prevalence and severity [2], worse sleep, and reduced quality of life [1], compared to people with OSA alone. A study by Choi et al. previously found that among 117 sleep clinic patients with untreated OSA, insomnia symptoms were positively associated suicidal ideation after controlling for age and gender [3]. Udholm et al. recently reported on the association between diagnosed OSA and risk of suicide and self-harm in a Danish Nationwide cohort [4]. Compared to age- and gender-matched people with no OSA diagnosis, people with a diagnosis of OSA had an increased risk of self-harm (composite variable), and death by suicide, over a mean follow-up of 12.5 years. Of interest, positive airway pressure (PAP) therapy appeared to moderate this association, with a trend for reduced risk of suicide, and a significant reduction in risk of self-harm among the diagnosed group treated with PAP, compared to those without PAP. This research makes an important contribution to knowledge of relationships between sleep disorders and mental health, and raises important avenues of future scientific investigation to reduce the very high personal, societal and economic cost of sleep disorders, depression, self-harm, and suicide risk.