| BackgroundObstructive Sleep Apnea(OSA)is the most common form of sleep disordered breathing(SDB),which seriously affects the quality of life of patients.Patients with OSA often present with apnea,snoring,excessive daytime sleepiness,frequent awakening,headache in the morning,decreased attention and memory and irritability,some of which also exist in psychiatric disorders.Depression is the most common serious mental illness,mainly referring to a range of symptoms or behaviors that individuals experience as a result of changes in thinking,activity,or mood that severely impair personal and social functioning,and sleep disturbances,including insomnia or sleepiness,are common symptoms of depression.Sleep disorders including insomnia or lethargy are common symptoms of depression.Previous studies have focused on the clinical and mechanistic studies of patients with OSA who exhibit depressive symptoms,however,there are fewer clinical and mechanistic studies on whether depressed patients have comorbid sleep disorders.Previous studies have found an increased risk of death in patients with OSA and depression,but there are no definitive studies to show whether depressive co-morbidities of OSA would further increase the risk of death in patients.Therefore,the aim of this study was to investigate the correlation between depressive symptoms and the risk of developing OSA,as well as the risk of death in depressive co-morbid OSA.MethodsData for this study were obtained from the National Health and Nutrition Examination Survey(NHANES)database,selected from 2005-2008,and included a total of 7897 subjects.The degree of depression was assessed using the Patient Health Questionnaire(PHQ-9),and subjects were divided into 4 groups according to PHQ-9scores: no depression,mild depression,moderate depression,and major depression;the risk of OSA was assessed using a combination of sleep and blood pressure questionnaires,and subjects were divided into 2 groups: low-risk and high-risk groups.Binary logistic regression models and restricted cubic spline models were used to analyze the correlation between depressive symptoms and the risk of OSA.Based on PHQ-9 scores and OSA prevalence risk,subjects were divided into 4 groups: healthy group,OSA group,depression group and depression co-morbid OSA group,Kaplan-Meier(K-M)curves were drawn to analyze the risk of death in each group,and Cox regression models were constructed to calculate the risk ratio of death in each group to assess the effect of depression,OSA and depression co-morbid OSA on the risk of death.ResultsThe results of the binary logistic regression model and the restricted cubic spline regression model showed that the risk of OSA increased in the mild depression,moderate depression,and major depression groups after controlling for potential confounders,and the slope between the degree of depression and the risk of OSA showed an increasing nonlinear relationship,and the risk of OSA increased in women compared with men as the degree of depression increased.The K-M curves suggested that the mortality rate was from low to high in the healthy,depression,OSA,and depression co-morbid OSA groups,respectively;the COX regression results showed that depression co-morbid OSA was still independently associated with mortality risk after adjusting for confounding factors.ConclusionsThere is a positive correlation between the severity of depression and the risk of OSA,and there is a gender difference in the correlation between the two.Patients with major depression have an increased risk of OSA compared with men,and patients with depression combined with OSA have a significantly higher risk of death compared with those with depression and OSA alone,which is a risk factor for death.Therefore,it is necessary to further improve nocturnal polysomnography monitoring for early detection and treatment of OSA in patients with major depression who have sleep disorders. |
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