Sleep disturbance has profound impacts on physical and mental health during child development. Obstructive sleep apnea (OSA) is one of the conditions to disrupt sleep quality and cause sleep disturbances. According to a new study led by Prof. Po-Hsiu Kuo of National Taiwan University (NTU), with Dr. Wen-Che Tseng at National Taiwan University Hospital as first author, suspected sleep apnea among adolescents significantly increased the risk of suicidal ideation. This effect was partly independent of depression and students’ perceived stress. The study has been published online since 16 Sep 2018 in European Child & Adolescent Psychiatry.
The data of this study are from a subset of a cohort consists of approximately four-thousands school students in Taiwan. “Overall, 8.8 percent of students aged 10–14 years reported having recent suicidal ideation,” said Dr. Kuo. This is alarming as suicidal ideation is a prominent risk factor for suicidal attempts. Previous studies in the literature have found that sleep-related traits were associated with suicidal behaviors in adolescents, including sleep duration, insomnia, and sleep disturbances. Findings in this study extend the current knowledge for the impacts of sleep disorders on youth suicidal ideation.
OSA is the most common sleep disorder in children. Depending on the screening criteria, 33 percent students had suspected sleep apnea using daytime sleepiness, and the prevalence dropped to 3.8 percent when adding the criterion of disordered breathing. Regardless of using different screening criteria, suspected pediatric OSA significantly increased the risk of suicidal ideation. “Students with suspected pediatric OSA had an odds ratio of 3.25 (95 percent CI=1.90-5.56, p<0.001) for suicidal ideation, and this association remained significant (OR=2.25, 95 percent CI=1.23-4.25, p=0.015) after controlling for depression and perceived stress,” said Dr. Tseng. Using the more stringent criteria for screening suspected OSA, the risk for suicidal ideation increased to an odds ratio of 7.38 (95 percent CI=2.92-18.62, p<0.001), though the effect was attenuated when depression and perceived stress were included in the models.
Suicide prevention is critical and actionable by identifying modifiable risk factors, especially in children and adolescents. Sleep-related behaviors and parameters are recognized as modifiable factors for suicide. Most importantly, treatment of sleep disturbances has recently emerged as a practical tool for promoting mental health, for which prior evidence supports the effectiveness of sleep-oriented interventions and treatment for reducing suicidal risk.
In conclusion, pediatric suspected sleep apnea is common in school students, and was associated with suicidal ideation that was partly independent of depression and stress. We suggest that sleep apnea is screened in addition to other sleep problems in children, in the hope of providing timely treatment for pediatric OSA to reduce youth suicidal behavior.