According to findings from a cohort study, patients with obstructive sleep apnea (OSA) were more likely than healthy controls to develop depressive and anxiety disorders over a 9-year follow-up.
The study, published in JAMA Otolaryngology-Head & Neck Surgery, notes that previous reviews have found a higher prevalence of OSA in those with depressive and anxiety disorders, and other studies have found that the psychiatric comorbidities commonly seen with OSA can worsen quality of life and reduce adherence to therapy. The current study used a large, nationwide sample to examine the association between OSA and the risk of affective disorder after adjusting for clinical and demographic variables.
Using a representative cohort sample of more than 1 million adults from the 2002-2013 National Sample Cohort of the Korea National Health Insurance Service, researchers identified a group of 197 patients who were diagnosed with OSA between 2004 and 2006 and a comparison group of 788 patients without OSA. None of the patients had a diagnosis of depressive or anxiety disorder at the time of enrollment, and the groups were matched on age, sex, residential area, household income, disability, and comorbidities.
Over 9 years of follow-up, the overall incidence of affective disorders was significantly higher in the OSA group than in the comparison group (49.57 vs 27.18 per 1000 person-years; adjusted hazard ratio [HR], 2.04). Within the OSA group, there was a higher incidence of anxiety disorders than depressive disorders (34.61 vs 28.35 per 1000 person-years); both of these were higher than the incidences seen in the comparison group.
Adjusted HRs for developing a new affective disorder over the 9-year follow-up for individuals with OSA were 2.90 (95% CI, 1.98-4.24) for depression and 1.75 (95% CI, 1.26-2.44) for anxiety. Women with OSA were more likely to develop depression (adjusted HR, 3.97 [95% CI, 1.54-10.19]) and anxiety (adjusted HR, 2.42 [95% CI, 1.17-5.02]) than were men with OSA (depression: adjusted HR, 2.74 [95% CI, 1.80-4.17]; anxiety: adjusted HR, 1.64 [95% CI, 1.13-2.39]).
According to the study authors, previous research has posited that oxygen desaturation during sleep may contribute to the presentation of psychological symptoms in patients with OSA, but other studies have not proven associations between OSA severity (as measured by apnea/hypopnea index) and psychological symptoms. Other researchers have suggested structural or metabolic changes in the brain as a mechanism for the higher rates of mood disorders among individuals with OSA.
Although this study could not suggest a cause of the relationship between OSA and affective disorder, and it lacked information on some potential confounding factors (eg, body mass index, smoking), the finding of higher incidence of these disorders in patients with OSA is important knowledge for healthcare providers who treat patients with OSA, the study authors wrote.
“Clinicians may consider taking specific precautions to reduce the risks of development of depressive and anxiety disorders among patients with OSA,” they concluded. “Studies that investigate the OSA management and the risk of developing affective disorders may yield strategies for effective prevention and intervention practices.”
Kim JY, Ko I, Kim DK. Association of obstructive sleep apnea with the risk of affective disorders [published online September 12, 2019]. JAMA Otolaryngol Head Neck Surg. doi: 10.1001/jamaoto.2019.2435.