OSA rates up on weekends

The incidence of obstructive sleep apnoea (OSA) is higher on weekends than on weekdays, a study reports.

“This real-world study evaluating day-of-week variations in OSA severity in >70,000 users [of a home OSA monitor] revealed a global increase in OSA severity on weekends, a phenomenon we have termed ‘social apnoea’,” the researchers said.

The odds of OSA (apnoea-hypopnoea index [AHI] ≥15 events/hr) were higher on Saturdays than Wednesdays (odds ratio [OR], 1.18), with greater effects in men vs women (ORs, 1.21 vs 1.09) and younger vs older participants (<60 vs ≥60 years; ORs, 1.24 vs 1.07). [Am J Respir Crit Care Med 2025;doi:10.1164/rccm.202505-1184RL]

The investigators attributed the short-term variability in OSA severity to certain factors. For one, weekends are typically associated with increased alcohol intake and smoking. [Injury 2015;46:898-901] This might explain the intensified incidence of ‘social apnoea’ in men and younger individuals – demographic subgroups associated with higher alcohol intake and smoking behaviours. [Current Cardiovascular Risk Reports 2007;1:379-383]

The researchers also attributed their findings partly to non-use or lower use of continuous positive airway pressure (CPAP) on weekends, because guidelines have defined adequate CPAP adherence as device use for ≥4-hr/night on at least 70 percent of the week to accommodate non- or lower use on weekends. [Am J Respir Crit Care Med 2023;207:244-254]

Weekend catch-up sleep of ≥45 min and social jetlag of ≥60 min were also associated with a further increase in the weekend odds of OSA by 47 percent and 38 percent, respectively. This correlates with evidence reflecting an association between irregular sleep and higher odds of OSA. [Sleep 2024;47:zsae001] “Since OSA is typically more severe during REM sleep, weekend catch-up sleep and social jetlag are likely to exacerbate OSA severity,” the researchers said.

Clinical implications

Data were obtained from a cohort of 70,052 adults (mean age 53 years, 81 percent men, mean BMI 28.8 kg/m²) using a validated under-mattress sleep sensor. Average AHI was 18 events/hr, sleep duration was 7.3 hrs, weekend catch-up sleep was 25 mins, and social jetlag was 42 mins.

“[The] systematic difference in OSA severity by day of week across years and countries underscores the existence of an underlying significant night-to-night variability in OSA severity, which is currently not captured by gold standard single-night sleep tests,” the researchers noted. “These findings further highlight the potential for OSA misdiagnosis and misclassification, with conventional OSA testing typically occurring on weeknights.”

Limitations that should be taken into context include the overrepresentation of men, lack of data on potential effect modifiers (eg, diet, exercise, alcohol intake, smoking, bedroom temperature, work schedules, among others), and lack of evaluation of the sensor’s ability to detect naps. There may also be inherent self-selection bias, as device owners may be more aware of their health and exhibit different sleep behaviours.

“[Also,] social jetlag and ‘social apnoea’ were calculated using weekday vs weekend comparisons rather than work vs non-workdays, which may have led to misclassification of certain participants,” they added.

Further investigation is thus warranted to ascertain the causes and mechanisms behind this novel ‘social apnoea’ phenomenon, the researchers said.

“Regardless of the underlying mechanisms, the observed increase in OSA severity on weekends may carry significant population-level societal costs, given the high prevalence and wide-ranging health and safety implications of OSA,” the researchers said. “Indeed, previous health economic analyses of OSA burden suggest that small variations in OSA prevalence may yield large well-being burden and costs at the population level.”