Social Worsening of Obstructive Sleep Apnea
- Christine Daecher, DO
- Aug 27
- 5 min read
A new study suggests that obstructive sleep apnea (OSA) may actually worsen on weekends—a phenomenon researchers are now calling “social apnea.”
Perhaps you’ve noticed that your bed partner snores more after a few alcoholic drinks. On those nights, you may also observe pauses in breathing, loud gasps for air, or restless movements during sleep. If so, you’re not imagining things—these patterns are real.
According to recently published research, OSA tends to be more severe on weekends, likely due to factors such as alcohol use and irregular sleep schedules. Depending on how one defines the weekend, this could mean that for three nights out of the week, sleep apnea symptoms are more pronounced.
What is Obstructive Sleep Apnea (OSA)?
Obstructive sleep apnea (OSA) is a sleep disorder marked by repeated episodes of partial or complete airway obstruction during sleep. These events lead to disrupted breathing, drops in blood oxygen levels, and poor-quality sleep. If left untreated, OSA carries significant health risks. The obstruction occurs when the soft tissues of the throat—such as the tongue, soft palate, and pharyngeal walls—relax and block airflow.
Often, it is a bed partner who first notices the signs. Common nighttime symptoms include loud, chronic snoring, gasping or choking, and pauses in breathing that are usually followed by a loud inhalation. During the day, people with OSA may experience morning headaches, difficulty with concentration or memory (“brain fog”), dry mouth or sore throat upon waking, and significant daytime fatigue and sleepiness.
While OSA can sometimes be suspected clinically based on symptoms, an official diagnosis typically requires a sleep study (polysomnogram)—either at home or in a sleep lab. The severity of OSA is determined using the apnea-hypopnea index (AHI).
The AHI measures the number of apneic events per hour. An event is scored when airflow is reduced by at least 30% for ≥10 seconds along with either a ≥3% drop in oxygen saturation (for example, from 97% to 94% on a pulse oximeter) or an EEG-detected arousal.
OSA Severity & It's Health Risks
To be formally diagnosed with obstructive sleep apnea (OSA), a person must experience at least five apneic events per hour of sleep. Each event triggers a brief awakening in the brain, disrupting normal sleep architecture. To put this in perspective, someone who wakes up 32 times over the course of an eight-hour night (about four times per hour) would not meet the criteria for OSA, while another person who wakes up 40 times in the same period would.
Once diagnosed, OSA severity is classified based on the apnea-hypopnea index (AHI):
Mild OSA: 5–14 events per hour
Moderate OSA: 15–29 events per hour
Severe OSA: ≥30 events per hour
OSA not only leads to poor sleep, morning headaches, and daytime fatigue, but it also significantly raises the risk of serious health problems. These include high blood pressure that is often difficult to control, atrial fibrillation, stroke, heart attack, type 2 diabetes, cognitive decline and dementia, and depression. In addition, OSA greatly increases the risk of motor vehicle accidents.
OSA Severity and Social Factors
A recent study published in the American Journal of Respiratory and Critical Care Medicine found that obstructive sleep apnea (OSA) tends to worsen on weekends, particularly in men and younger adults. Interestingly, the researchers defined "younger" as under 60.
Researchers analyzed sleep data from more than 70,000 adult users of an under-mattress home OSA monitor. Data was collected between 2020 and 2023 using FDA-cleared home sleep monitoring devices (Withings Sleep Analyzer/Sleep Rx).1,2 They discovered that individuals completing their studies on Saturdays were 18% more likely to have moderate-to-severe OSA compared with those tested midweek, on Wednesdays. 2 When looking at sex differences, the weekend effect was more pronounced in men, who showed a 21% increase in severity, compared with women, who had only a 9% increase.1
Several lifestyle factors may help explain this weekend pattern. Alcohol consumption is one likely contributor, as alcohol is both a central nervous system depressant and a direct muscle relaxant. Because OSA is driven by relaxation and collapse of the upper airway muscles, alcohol use can significantly worsen symptoms. Smoking may also play a role by contributing to airway irritation and inflammation. In addition, changes in sleep timing are important.
The researchers found that “catch-up sleep”—defined as extending sleep by 45 minutes or more—was associated with a 47% increased odds of OSA.2 Similarly, shifting bedtime and wake time by at least one hour raised the risk of worsened apnea by 38%. 2 This phenomenon of altered sleep schedules is now being referred to as “social jet lag.”
Like any research, this study has important limitations that should be kept in mind. The participants were a self-selected group, as individuals who purchased and used a home sleep sensor are likely more health-conscious and may have sleep behaviors that differ from the general population. The analysis was also limited to people with confirmed OSA, defined as at least five apneic events per hour (AHI ≥5). In addition, men were overrepresented in the sample, which may reduce the generalizability of the findings. The study did not account for other potential influences on sleep and OSA severity, such as diet, physical activity, alcohol or caffeine intake, smoking, bedroom environment, work schedules, ethnicity, comorbidities, or treatment use such as CPAP. Another limitation is that the device used has not been validated for detecting naps, preventing any assessment of the potential contribution of daytime sleep. Finally, the definitions of “social jet lag” and “social apnea” were based on weekday versus weekend comparisons rather than workdays versus non-workdays, which may have led to misclassification in participants with nontraditional or shift work schedules.
Using this study
There are several important takeaways from this study. Traditional polysomnograms performed in a sleep laboratory are typically scheduled during the week and may fail to capture the weekend worsening of symptoms linked to lifestyle changes. In fact, the diagnostic accuracy of a single-night polysomnogram is estimated to be only about 20%. For this reason, I often recommend a three-night home sleep study as a more reliable initial screening tool for OSA. Moving forward, I will also be advising patients to include both a typical weekday and weekend night in their testing.
Maintaining a consistent sleep schedule throughout the entire week provides significant benefits for overall sleep health. Likewise, keeping alcohol intake to one or two days per week (or less) and reducing the amount consumed may help lower the risk of worsening sleep apnea and promote better sleep quality.
References:
For a Withings Sleep pad: https://www.withings.com/us/en/sleep
Pinilla L, Lechat B, Scott H, Reynolds AC, Manners J, Sansom K, Adams R, Escourrou P, Catcheside P, Eckert DJ. "Social Apnea": Obstructive Sleep Apnea is Exacerbated on Weekends. Am J Respir Crit Care Med. 2025 Aug 13. doi: 10.1164/rccm.202505-1184RL. Epub ahead of print. PMID: 40801527.
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