0544 Occult Obstructive Sleep Apnea Increases Risk for Depression among Older Adult Medicare Beneficiaries

Abstract

Abstract Introduction Depression and obstructive sleep apnea (OSA) are highly comorbid, and each is independently associated with worsened health outcomes and increased economic burden. This study aimed to determine the effect of occult OSA on incident depression among a national sample of Medicare beneficiaries. We hypothesized that relative to non-sleep disordered controls, older adults with occult OSA would demonstrate greater risk for incident depression during the year prior to OSA diagnosis. Methods Our data source was a random 5% sample of Medicare administrative claims data from 2006-2013. Obstructive sleep apnea, depression, and medical comorbidities were defined using International Classification of Disease, Version 9, Clinical Modification diagnostic codes during the twelve months prior to OSA diagnosis. Beneficiaries with history of depression prior to the beginning of follow-up (12 months before OSA diagnosis) were excluded. Non-sleep disordered controls were required to possess no evidence of sleep-related diagnosis, testing, or treatment during the study period. Log binomial regression was used to model risk for incident depression as a function of occult OSA. Inverse probability of treatment weights were used to balance covariates between exposure groups. Results The final sample included a total of 21,116 beneficiaries with occult OSA and 237,375 individuals without sleep disorders. In fully adjusted models, beneficiaries with OSA demonstrated significantly higher risk of depression during the year prior to OSA diagnosis (risk ratio 3.19; 95% confidence interval 3.00, 3.39). Conclusion In this national study of older adult Medicare beneficiaries, occult OSA was associated with three-fold risk of incident depression. Future research should 1) examine the disease burden including health and economic consequences, of comorbidity OSA and depression and 2) also seek to determine the effect of screening, assessing, and treating OSA on risk for depression. Support (if any) This research was supported by an investigator-initiated grant from the ResMed Foundation to the University of Maryland, Baltimore (PI: EMW).