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This article presents the state of the science of anxiety in middle-aged men with obstructive sleep apnea (OSA). OSA affects 10% of men in this population. Psychological outcomes, especially anxiety, have a significant impact on quality of life, yet are essentially ignored.Search of CINAHL, MEDLINE, PsycINFO, and PsycARTICLES, with the key words “sleep apnea” and “anxiety” and with age and gender limits, resulted in 107 articles. Based on established inclusion criteria, 71 studies were excluded. The resulting 36 studies were critically evaluated by sample characteristics, anxiety measurement, and results.Anxiety was noted in 34 of the 36 samples, most commonly measured using the Hospital Anxiety and Depression Scale, the State Trait Anxiety Inventory, and the Beck Anxiety Inventory. Effects of treatment on anxiety were significant.Anxiety is common in middle-aged men with OSA, but is not adequately studied in this population. Psychological screening for anxiety at the time of OSA diagnosis is warranted, but is not encouraged in the clinical guidelines. More primary care attention is needed on psychological implications that impact OSA treatment adherence. Advanced practice nurses can be instrumental in ensuring comprehensive assessment of patients with OSA, especially psychological aspects of the disease.