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Background: Studies reported the strong link between Obstructive Sleep Apnea (OSA) and Major Depressive Disorder (MDD). However, the risk for OSA in patients with chronic treatment resistant depression (cTRD) is not well documented worldwide. Objectives: We assessed the risk for OSA and associated factors in cTRD patients. Methods: The study recruited 140 Iranian patients with cTRD. All patients completed the Berlin questionnaire, which evaluates the risk of OSA. Additionally, demographic data and history of cardiovascular and metabolic diseases were collected. Pearson's Chisquare test, Fisher's exact test, and independent T-test were used to assess group differences, when appropriate. Results: The study found that 89 of 140 cTRD patients (64%) were at high risk for OSA. Group comparison between cTRD patients (high vs. low risk for OSA) demonstrated that at high risk OSA-cTRD patients had an elevated rate of hypertension, diabetes mellitus, and obesity. Also, age, duration of depression, and duration of treatment were significantly higher in cTRD patients with higher risk compared to those with lower risk OSA"for "Also, age, duration of depression, and duration of treatment were significantly elevated in high versus low risk cTRD patients. Conclusions: The results suggest that a noticeable number of patients with cTRD are at high risk for OSA, which is larger than the reported magnitude in the general population. Moreover, hypertension, diabetes mellitus, and obesity are associated with a higher risk for OSA. Also, age, treatment duration, and depression duration could be considered as possible comorbid factors for OSA in patients with cTRD. [ABSTRACT FROM AUTHOR]