title: Sleep apnea is associated with an increased risk of mood disorders: a population-based cohort study.
abstract: OBJECTIVE
  The symptoms of sleep apnea, such as sleep fragmentation and oxygen desaturation, might be risk factors for subsequent mood disorder (MD), but associations between sleep apnea and MD remain unclear. This nationwide population-based study thus aimed to identify the risk of MD in patients with vs. without sleep apnea.
  
  
  METHODS
  This cohort study used data from the National Health Insurance database. In total, 5415 patients diagnosed with sleep apnea between 2000 and 2010 were evaluated, and 27,075 matched non-sleep apnea enrollees were included as a comparison cohort. All subjects were followed until 2011. The Cox proportional hazard ratio (HR) was used to investigate the relationship between MD and sleep apnea while controlling covariates and comorbidities of sleep apnea.
  
  
  RESULTS
  Of 5415, 154 patients with sleep apnea (2.84 %) were diagnosed with MD during the follow-up period in comparison with 306 of 27,075 individuals (1.13 %) without antecedent sleep apnea. After adjusting for the selected factors and comorbidities, we found that patients with sleep apnea were from 1.82- to 2.07-fold greater risk of MD than the comparisons. Of the three subcategories of MD (major depressive disorder, bipolar disorder, and unspecified MD), sleep apnea had the highest predisposing risk with respect to major depressive disorder (adjusted HR from 1.82 to 2.07) and bipolar disorder (adjusted HR from 2.15 to 3.24).
  
  
  CONCLUSIONS
  There is a greater likelihood of MD manifesting in patients with a history of sleep apnea. Health professionals are thus advised to carefully monitor the psychological impacts of sleep apnea.
authors: Department of Health, Jianan Mental Hospital, Tainan, Taiwan.|Department of Applied Life Science and Health, Chia Nan University of Pharmacy and Science, Tainan, Taiwan.
authors: Ming-Kun
authors: MK
authors: Lu
authors: Department of Psychiatry, Kaohsiung Veterans General Hospital Tainan Branch, Tainan, Taiwan.|Department of Acupressure Technology, Chung Hwa University of Medical Technology, Tainan, Taiwan.|Department of Environmental and Occupational Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
authors: Hung-Pin
authors: HP
authors: Tan
authors: Institute of Clinical Medicine, College of Medicine, National Cheng Kung University, 138, Shengli Road, Tainan, Taiwan.
authors: I-Ning
authors: IN
authors: Tsai
authors: Institute of Clinical Medicine, College of Medicine, National Cheng Kung University, 138, Shengli Road, Tainan, Taiwan.|Chia Nan University of Pharmacy and Science, Tainan, Taiwan.|Department of Psychiatry, Chia-Yi Branch, Taichung Veterans General Hospital, Chia-Yi, Taiwan.
authors: Li-Chung
authors: LC
authors: Huang
authors: Institute of Clinical Medicine, College of Medicine, National Cheng Kung University, 138, Shengli Road, Tainan, Taiwan.|Division of Pulmonary Medicine, Department of Internal Medicine, National Cheng Kung University Hospital, Tainan, Taiwan.
authors: Xin-Ming
authors: XM
authors: Liao
authors: Institute of Clinical Medicine, College of Medicine, National Cheng Kung University, 138, Shengli Road, Tainan, Taiwan. shlin922@mail.ncku.edu.tw.|Biostatistics Consulting Center, National Cheng Kung University Hospital, Tainan, Taiwan. shlin922@mail.ncku.edu.tw.
authors: Sheng-Hsiang
authors: SH
authors: Lin
mesh_terms: D000328:Adult; D001714:Bipolar Disorder / Q000175:diagnosis / Q000453:epidemiology; D015984:Causality; D015331:Cohort Studies; D003430:Cross-Sectional Studies; D003865:Major Depressive Disorder / Q000175:diagnosis / Q000453:epidemiology; D005260:Female; D006801:Humans; D016013:Likelihood Functions; D008297:Male; D008875:Middle Aged; D019964:Mood Disorders / Q000175:diagnosis / Q000453:epidemiology*; D016016:Proportional Hazards Models; D012306:Risk; D020181:Sleep Apnea, Obstructive / Q000175:diagnosis / Q000453:epidemiology*; D013624:Taiwan
keywords: Bipolar disorder; Major depressive disorder; Mood disorder; Nationwide population-based study; Sleep apnea