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<title>Abstract</title> <bold>Background</bold> Both obstructive sleep apnoea (OSA) and depressive symptoms have been independently associated with adverse perinatal outcomes. However, defining the individual contribution of each condition to adverse perinatal outcomes is difficult because many pregnant women with OSA also have depressive symptoms. This observational study aimed to investigate the relationship between OSA in pregnancy and perinatal outcomes, accounting for the confounding effects of depressive symptoms. <bold>Methods</bold> 122 pregnant women (≥ 26 weeks’ gestation) from a tertiary maternity hospital were included in this study, which measured OSA (by monitoring overnight oxygen saturation and airflow) and depressive symptoms (using the Edinburgh Postnatal Depressive Scale). Medical records were reviewed, and maternal and newborn outcomes recorded. Binary logistic regression was used to assess the association of maternal and newborn outcomes with OSA, accounting for depressive symptoms. <bold>Results: </bold>Newborns of mothers with OSA had 18 times the odds of having an Apgar score of < 7 at 5 minutes after birth after accounting for depressive symptoms and body mass index (BMI). However, no association with arterial cord blood pH or lactate was found. Preterm birth (birth at < 37 weeks of gestation) was not associated with OSA but was associated with increasing depressive symptoms; women who screened positive for depressive symptoms were almost 7 times more likely to have a preterm infant. Mothers with more frequent dips in oxygenation > 3% had higher birthweight infants after accounting for BMI and depressive symptoms. No associations between maternal OSA, gestational hypertensive disorders, gestational diabetes or caesarean delivery were found. <bold>Conclusions </bold>This study shows OSA relates to newborns with low Apgar scores after birth and that depressive symptoms relate to preterm birth. As there appears to be an overlap between depressive symptoms and the presence of OSA, considering both psychological interventions and OSA treatment may be valuable in improving perinatal mental health and infant wellbeing.