title: Associations of Undiagnosed Obstructive Sleep Apnea and Excessive Daytime Sleepiness With Depression: An Australian Population Study.
abstract: OBJECTIVE
  To determine whether undiagnosed obstructive sleep apnea (OSA) and/or excessive daytime sleepiness are associated with symptomatic depression in Australian men.
  
  
  METHODS
  Participants were randomly selected, urban community dwelling men aged 40 to 88 years without a prior diagnosis of OSA. Clinically significant depressive symptoms were assessed using the Beck Depression Inventory-1A or Centre for Epidemiological Studies Depression Scale (2007-2010). A random sample of men (n = 788) undertook full at-home unattended polysomnography (Embletta X100, Broomfield, Colorado, United States) and completed the Epworth Sleepiness Scale questionnaire (2010-2012).
  
  
  RESULTS
  Undiagnosed severe obstructive sleep apnea (apnea-hypopnea index ≥ 30 events/h) was associated with depressive symptoms (adjusted odds ratio = 1.98; 95% confidence interval [CI] 1.05-3.73;P= .036). However, a significant interaction was observed between obstructive sleep apnea and excessive daytime sleepiness (P= .03) such that individuals with OSA and excessive daytime sleepiness (Epworth Sleepiness Scale score of 10 or higher) exhibited the strongest associations with depression (mild-moderate apnea: adjusted odd ratio = 3.86; 95% CI 1.87-7.95; severe apnea: adjusted odd ratio = 4.82; 95% CI 1.42-16.35) when compared to individuals without apnea.
  
  
  CONCLUSIONS
  Depressive symptoms in men were associated with undiagnosed OSA in the community. It is important that clinicians and primary care practitioners consider screening for depression in men with severe OSA and for OSA in men with depression. Screening for depression should also be considered in men with excessive daytime sleepiness regardless of OSA severity.
authors.affiliation: The Health Observatory, Discipline of Medicine, University of Adelaide, The Queen Elizabeth Hospital Campus, Woodville, South Australia, Australia.|Basil Hetzel Institute for Translational Health Research, The Queen Elizabeth Hospital, Woodville, South Australia, Australia.
authors.forename: Carol J
authors.initials: CJ
authors.lastname: Lang
authors.affiliation: The Health Observatory, Discipline of Medicine, University of Adelaide, The Queen Elizabeth Hospital Campus, Woodville, South Australia, Australia.|Basil Hetzel Institute for Translational Health Research, The Queen Elizabeth Hospital, Woodville, South Australia, Australia.
authors.forename: Sarah L
authors.initials: SL
authors.lastname: Appleton
authors.affiliation: Adelaide Institute of Sleep Health, Flinders University of South Australia, c/o Repatriation General Hospital, Daw Park, South Australia, Australia.|NHMRC Centre for Integrated Research and Understanding of Sleep (CIRUS), Woolcock Institute of Medical Research, Central Clinical School, University of Sydney, New South Wales, Australia.
authors.forename: Andrew
authors.initials: A
authors.lastname: Vakulin
authors.affiliation: Adelaide Institute of Sleep Health, Flinders University of South Australia, c/o Repatriation General Hospital, Daw Park, South Australia, Australia.|School of Medicine, Flinders University, Bedford Park, Adelaide, South Australia, Australia.
authors.forename: R Doug
authors.initials: RD
authors.lastname: McEvoy
authors.affiliation: Freemason's Centre for Men's Health, Discipline of Medicine, University of Adelaide, Adelaide, South Australia, Australia.
authors.forename: Andrew D
authors.initials: AD
authors.lastname: Vincent
authors.affiliation: The Health Observatory, Discipline of Medicine, University of Adelaide, The Queen Elizabeth Hospital Campus, Woodville, South Australia, Australia.|Freemason's Centre for Men's Health, Discipline of Medicine, University of Adelaide, Adelaide, South Australia, Australia.
authors.forename: Gary A
authors.initials: GA
authors.lastname: Wittert
authors.affiliation: Freemason's Centre for Men's Health, Discipline of Medicine, University of Adelaide, Adelaide, South Australia, Australia.
authors.forename: Sean A
authors.initials: SA
authors.lastname: Martin
authors.affiliation: Population Research and Outcomes Studies, Discipline of Medicine, University of Adelaide, Adelaide, South Australia, Australia.
authors.forename: Janet F
authors.initials: JF
authors.lastname: Grant
authors.affiliation: Population Research and Outcomes Studies, Discipline of Medicine, University of Adelaide, Adelaide, South Australia, Australia.
authors.forename: Anne W
authors.initials: AW
authors.lastname: Taylor
authors.affiliation: Adelaide Institute of Sleep Health, Flinders University of South Australia, c/o Repatriation General Hospital, Daw Park, South Australia, Australia.|School of Medicine, Flinders University, Bedford Park, Adelaide, South Australia, Australia.
authors.forename: Nicholas
authors.initials: N
authors.lastname: Antic
authors.affiliation: Adelaide Institute of Sleep Health, Flinders University of South Australia, c/o Repatriation General Hospital, Daw Park, South Australia, Australia.|School of Medicine, Flinders University, Bedford Park, Adelaide, South Australia, Australia.
authors.forename: Peter G
authors.initials: PG
authors.lastname: Catcheside
authors.affiliation: The Health Observatory, Discipline of Medicine, University of Adelaide, The Queen Elizabeth Hospital Campus, Woodville, South Australia, Australia.
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Adams
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001315:Australia / Q000453:epidemiology; D015897:Comorbidity; D003866:Depressive Disorder / Q000453:epidemiology* / Q000523:psychology; D006970:Disorders of Excessive Somnolence / Q000453:epidemiology* / Q000523:psychology; D006801:Humans; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D012720:Severity of Illness Index; D020181:Sleep Apnea, Obstructive / Q000453:epidemiology*; D011795:Surveys and Questionnaires; D014505:Urban Population / Q000706:statistics & numerical data
keywords: depression; epidemiology; obstructive sleep apnea; polysomnography; population based community cohort; somnolence