title: The comorbidity of sleep apnea and mood, anxiety, and substance use disorders among obese military veterans within the Veterans Health Administration.
abstract: OBJECTIVE
  To determine the relations between obstructive sleep apnea (OSA) diagnosis, the likelihood of being diagnosed with a psychological condition, among obese veterans, after accounting for severity of obesity and the correlated nature of patients within facility. We hypothesized that (1) individuals with a diagnosis of OSA would be more likely to receive a diagnosis of a (a) mood disorder and (b) anxiety disorder, but not (c) substance use disorder.
  
  
  METHODS
  Cross-sectional retrospective database review of outpatient medical records between October 2009 and September 2010, conducted across all 140 Veterans Health Administration (VHA) facilities.
  
  
  METHODS
  The entire VA Health Care System.
  
  
  METHODS
  Population-based sample of veterans with obesity (N = 2,485,658).
  
  
  METHODS
  Physician- or psychologist-determined diagnosis of psychological conditions including mood, anxiety, and substance use disorders.
  
  
  RESULTS
  Using generalized linear mixed modeling, after accounting for the correlated nature of patients within facility and the severity of obesity, individuals with a diagnosis of sleep apnea had increased odds of receiving a mood disorder diagnosis (OR = 1.85; CI = 1.71-1.72; p < 0.001), anxiety disorder diagnosis (OR = 1.82; CI = 1.77-1.84; p < 0.001), but not a diagnosis of substance use disorder.
  
  
  CONCLUSIONS
  Among obese veterans within VA, OSA is associated with increased risk for having a mood and anxiety disorder, but not substance use disorder, with the strongest associations observed for posttraumatic stress disorder (PTSD) and major depressive disorder (MDD). In addition, this relation remained after accounting for severity of BMI.
authors: Center for Health Care Evaluation, VA Palo Alto Health Care System, Menlo Park, CA ; Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA.
authors: Kimberly A
authors: KA
authors: Babson
authors: A C
authors: AC
authors: Del Re
authors: Marcel O
authors: MO
authors: Bonn-Miller
authors: Steven H
authors: SH
authors: Woodward
mesh_terms: D001008:Anxiety Disorders / Q000453:epidemiology*; D015992:Body Mass Index; D015897:Comorbidity; D003430:Cross-Sectional Studies; D003865:Major Depressive Disorder / Q000453:epidemiology; D006801:Humans; D019964:Mood Disorders / Q000453:epidemiology*; D009765:Obesity / Q000453:epidemiology*; D016017:Odds Ratio; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D020181:Sleep Apnea, Obstructive / Q000453:epidemiology*; D013313:Stress Disorders, Post-Traumatic / Q000453:epidemiology; D019966:Substance-Related Disorders / Q000453:epidemiology*; D014481:United States; D014493:United States Department of Veterans Affairs / Q000706:statistics & numerical data; D014728:Veterans / Q000523:psychology / Q000706:statistics & numerical data*; D058014:Veterans Health / Q000706:statistics & numerical data
keywords: Sleep apnea; anxiety; depression; veterans