title: The prevalence and predictors of obstructive sleep apnea in major depressive disorder, bipolar disorder and schizophrenia: A systematic review and meta-analysis.
abstract: BACKGROUND
  Obstructive sleep apnea (OSA) is a health hazard since it is associated with neurocognitive dysfunction and cardio-metabolic diseases. The prevalence of OSA among people with serious mental illness (SMI) is unclear.
  
  
  METHODS
  We searched major electronic databases from inception till 06/2015. Articles were included that reported the prevalence of OSA determined by polysomnography (PSG) or an apnea-hypopnea index (AHI) >5 events/hr, in people with major depressive disorder (MDD), bipolar disorder (BD) or schizophrenia. A random effects meta-analysis calculating the pooled prevalence of OSA and meta-regression of potential moderators were performed.
  
  
  RESULTS
  Twelve articles were included representing 570,121 participants with SMI (mean age=38.3 years (SD=7.5)), 45.8% male (range=32-80.4) and mean body mass index (BMI) 25.9 (SD=3.7). The prevalence of OSA in SMI in clinical studies was 25.7% (95% CI 13.9 to 42.4%, n=1,535). Higher frequencies of OSA were seen in MDD (36.3%, 19.4-57.4%, n=525) than in BD (24.5%, 95% CI 10.6-47.1, n=681) and schizophrenia (15.4%, 95% CI 5.3-37.1%, n=329). The prevalence of OSA in 568,586 people with SMI from population cohort studies was 10.7% (95% CI 2.4-37.0%) and 19.8% (95% CI 2.5-70.0%) in 358,853 people with MDD. Increasing age (β=0.063, 95% CI 0.0005-0.126, p=0.04, N=10) and BMI predicted increased prevalence of OSA (β=0.1642, 95% CI 0.004-0.3701, p=0.04, N=9).
  
  
  CONCLUSIONS
  People with SMI (particularly MDD) have a high prevalence of OSA. Screening for and interventions to manage OSA in SMI including those focused on reducing BMI are warranted.
authors.affiliation: Health Service and Population Research Department, Institute of Psychiatry, King's College London, De Crespigny Park, London Box SE5 8AF, United Kingdom; Physiotherapy Department, South London and Maudsley NHS Foundation Trust, Denmark Hill, London SE5 8AZ, United Kingdom.
authors.forename: Brendon
authors.initials: B
authors.lastname: Stubbs
authors.affiliation: KU Leuven Department of Rehabilitation Sciences, Tervuursevest 101, B-3001 Leuven, Belgium; University Psychiatric Centre KU Leuven, Kortenberg, KU Leuven Department of Neurosciences, Leuvensesteenweg 517, B-3070 Kortenberg, Belgium.
authors.forename: Davy
authors.initials: D
authors.lastname: Vancampfort
authors.affiliation: Department of Medicine, DIMED, University of Padua, Via Gi ustiani, 2, 35128 Padova, Italy.
authors.forename: Nicola
authors.initials: N
authors.lastname: Veronese
authors.affiliation: Department of Neurosciences, University of Padua, Via Giustiniani, 5, 35128 Padova, Italy; Local Health Unit ULSS 17, Mental Health Department, Monselice, Padova, Italy.
authors.forename: Marco
authors.initials: M
authors.lastname: Solmi
authors.affiliation: National Psychosis Service, South London and Maudsley NHS Foundation Trust, Denmark Hill, London, United Kingdom.
authors.forename: Fiona
authors.initials: F
authors.lastname: Gaughran
authors.affiliation: Zucker Hillside Hospital, North Shore - LIJ Health System, 75-59 263rd Street, Glen Oaks, NY 11004, USA.
authors.forename: Peter
authors.initials: P
authors.lastname: Manu
authors.affiliation: Musculoskeletal Division, The George Institute for Global Health and School of Public Health, University of Sydney, Sydney, Australia; School of Psychiatry, University of New South Wales, Sydney, Australia.
authors.forename: Simon
authors.initials: S
authors.lastname: Rosenbaum
authors.affiliation: KU Leuven - University of Leuven, Department of Neurosciences, B-3000 Leuven, Belgium.
authors.forename: Marc
authors.initials: M
authors.lastname: De Hert
authors.affiliation: New York Psychiatric Institute, Columbia University, NYC, USA.
authors.forename: Michele
authors.initials: M
authors.lastname: Fornaro
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001714:Bipolar Disorder / Q000150:complications*; D015992:Body Mass Index; D003865:Major Depressive Disorder / Q000150:complications*; D006801:Humans; D008297:Male; D008875:Middle Aged; D017286:Polysomnography; D011237:Predictive Value of Tests; D015995:Prevalence; D012307:Risk Factors; D012559:Schizophrenia / Q000150:complications*; D020181:Sleep Apnea, Obstructive / Q000453:epidemiology* / Q000523:psychology*
keywords: Bipolar disorder; Major depressive disorder; Obstructive sleep apnea; Schizophrenia; Serious mental illness; Sleep