Lifestyle choices and irregular sleep patterns drive weekend spike in OSA severity

Late nights, alcohol, and smoking on weekends may be doing more than disrupting your Monday mornings, they could be triggering a newly identified sleep health concern known as 'social apnea', warn researchers from Flinders University.

Published in the prestigious American Journal of Respiratory and Critical Care Medicine, the international study introduces social apnea as a novel trend in sleep medicine referring to the weekend spike in Obstructive Sleep Apnea (OSA) severity, driven by lifestyle choices and irregular sleep patterns.

The research, which analyzed data from over 70,000 people worldwide, found a consistent and significant increase in OSA severity on weekends. Experts from FHMRI Sleep Health FHMRI Sleep Health coined the term 'social apnea' to describe this phenomenon.

Sleep apnea is already a major public health issue, but our findings suggest its true impact may be underestimated.

Most clinical diagnostic testing is done on a single night, typically a weeknight, missing the weekend effect we're now calling social apnea."

Dr. Lucia Pinilla, lead author and Research Fellow from FHMRI Sleep Health

Dr Pinilla explains that this weekend surge in sleep-disordered breathing may heighten the risk of serious health conditions including heart disease, depression, dementia, and extreme fatigue and motor vehicle and other accidents.

The study found that participants were 18% more likely to have moderate to severe OSA on weekends (Saturdays) when compared to mid-week (Wednesdays).

Changes in sleep schedules, such as staying up late on weekends or sleeping in, worsened sleep apnea.

Sleeping an extra 45 minutes or more on weekends increased the risk of worse sleep apnea by 47%. Men were 21% more likely to be affected, compared to a 9% increase in women.

Younger adults (under 60) had a 24% higher risk on weekends, compared to 7% in those aged 60 and above.

Matthew Flinders Professor Danny Eckert, Director of FHMRI Sleep Health and senior author on the paper says this is the first evidence that OSA severity increases at the weekend.

"We don't yet know exactly why, but alcohol use, lighter sleep, and less consistent use of OSA therapies likely play a role."

Dr. Bastien Lechat, lead author of a separate article just published in the prestigious Nature's Communications Medicine journal says similar mechanisms may drive seasonal variability in OSA severity.

"OSA tends to be worse during summer and winter, with severity increasing by 8–19% compared to spring and autumn," says Dr. Lechat.

"This seasonal spike is partly explained by higher temperatures, which disrupt sleep and lead to lighter sleep stages which is associated with worse OSA. In winter, longer sleep and later wake up times, increase time spent in REM sleep, which is also linked to more frequent apnea events."

Professor Eckert says that these findings align with the concept of 'social apnea' and highlight the need for multi-night sleep assessments and more personalised approaches to diagnosis and treatment.

"Relying on a single-night sleep study may miss important variations, leading to underdiagnosis or misclassification of OSA severity," says Professor Eckert.

To combat 'social apnea', Professor Eckert recommends maintaining a regular sleep routine.

"Try to keep the same sleep schedule throughout the week and weekend, ensuring that you get the recommended 7-9 hours of sleep a night," he says.

"Keeping a fixed wake-up time and using your prescribed OSA therapy, even on weekends, and going to bed when you feel sleepy will help ensure you frequently get enough restorative sleep which can help combat the weekend spike in OSA."

OSA is a common sleep disorder affecting around one billion people globally. It is caused by repeated airway collapse during sleep and, if untreated, increases the risk of heart disease, diabetes, cognitive decline, depression, and even death. People concerned about their sleep should speak with their GP.