Obstructive sleep apnea and the subsequent risk of depressive disorder: a population-based follow-up study

J Clin Sleep Med. 2013 May 15;9(5):417-23. doi: 10.5664/jcsm.2652.


Study objectives: Empirical findings on the prospective link between obstructive sleep apnea (OSA) and subsequent depression are mixed. This nationwide, population-based study thus aimed at assessing the risk of depressive disorder within the first year following a diagnosis with OSA. Gender effects were further examined.

Design: Cohort study.

Setting: Taiwan.

Patients: This study used data from the Longitudinal Health Insurance Database 2000. A total of 2,818 patients diagnosed with OSA between 2002 and 2008 were evaluated, and 14,090 matched non-OSA enrollees used as a comparison cohort.

Measurements and results: Each patient was followed for one year to identify subsequent depressive disorder. We found that during the one-year follow-up, the incidence of depressive disorder per thousand person-years was about twice as high among patients with OSA (18.10, 95% CI = 13.62-23.61) as those without OSA (8.23, 95% CI = 6.83-9.84). The Cox proportional hazards model revealed that patients with OSA were independently associated with a 2.18 times (95% CI = 1.55-3.08) increased risk of subsequent depressive disorder within a year, compared to those without OSA. As epidemiological studies have consistently documented an increased risk for depression in women, we hypothesized and confirmed higher risks of depressive disorder among female patients with OSA (2.72, 95% CI = 1.68-4.40) than their male counterparts (1.81, 95% CI = 1.09-3.01).

Conclusion: A prospective link between OSA and subsequent depressive disorder within one year was confirmed by the current study. The risk was particularly evident among women. Regular psychiatric screening among patients with OSA is suggested to prompt the timely detection of depression.

Commentary: A commentary on this article appears in this issue on page 425.

Keywords: Obstructive sleep apnea; depressive disorder; prospective link.

MeSH terms

  • Adult
  • Age Distribution
  • Aged
  • Causality
  • Cohort Studies
  • Comorbidity
  • Depressive Disorder / epidemiology*
  • Depressive Disorder / psychology
  • Female
  • Follow-Up Studies
  • Humans
  • Incidence
  • Longitudinal Studies
  • Male
  • Middle Aged
  • Proportional Hazards Models
  • Prospective Studies
  • Retrospective Studies
  • Risk Factors
  • Sex Distribution
  • Sleep Apnea, Obstructive / epidemiology*
  • Sleep Apnea, Obstructive / psychology
  • Taiwan / epidemiology