Depression Paradox in Cardiovascular Outcomes of Adult Patients with Obstructive Sleep Apnea: Insights from 2 Million...

Depression is a frequent comorbidity in obstructive sleep apnea (OSA) patients. There is a scarcity of data on the impact of depression on the outcomes of OSA.

Using the National Inpatient Sample (2018), we identified hospitalizations in the US with OSA. Following propensity-score matching, the two cohorts of OSA with depression (OSA+D+) vs. without depression (OSA+D-) were compared for demographic and comorbidities profiles differences. Multivariable regression analyses were performed to assess the odds of events with depression versus those without.

Of 2,169.730 hospitalizations in patients with OSA, 20.1% had comorbid depression. Matched cohorts included 846,150 admissions in both groups: OSA+D+ and OSA+D-. Both cohorts predominantly comprised Caucasians, the elderly (median age, 64 vs. 65 years), and females (55.5% vs. 55.2%). OSA+D+ cohort had a higher prevalence of hypertension, diabetes, hyperlipidemia, congestive heart failure, anemia, smoking, substance abuse, prior myocardial infarction (MI), transient ischemic attack (TIA), TIA/stroke, and venous thromboembolism than the OSA+D- group (all P < 0.001). Paradoxically, there was decreased risk of all-cause mortality [odds ratios (OR): 0.79, 95% confidence interval (CI): 0.73-0.86], major adverse cardiac and cerebrovascular events (OR: 0.83, 95% CI: 0.80-0.87), acute MI (OR: 0.80, 95% CI: 0.76-0.85), dysrhythmia/atrial fibrillation (OR: 0.81, 95% CI: 0.79-0.83), and cardiac arrest including ventricular fibrillation (OR: 0.65, 95% CI: 0.73-0.82) in the OSA+D+ cohort (P < 0.001).

OSA+D+ patients had better in-hospital outcomes as compared to OSA+D- despite having a higher burden of comorbidities. Additional research is warranted to validate this paradoxical effect of depression in OSA.