Abstract 11760: Depression Paradox for In-Hospital Cardiovascular Outcomes in Obstructive Sleep Apnea - A National Population-Level Analysis

Abstract

Background: ​​Depression is a frequently encountered comorbidity in patients with Obstructive Sleep Apnea (OSA), with a higher prevalence than the general population. However, there is limited data on the impact of psychiatric comorbidities on the outcomes of OSA. Methods: We identified OSA hospitalizations using the National Inpatient Sample (2018) and relevant ICD-10 codes. After propensity score matching, demographics and comorbidities were compared between the two groups of OSA with (OSA-D+) vs without depression (OSA-D-). The odds of in-hospital outcomes between them were analysed using multivariable regression analyses. Results: Of the 2169730 OSA hospitalizations, 20.1% had comorbid depression. Matched cohorts included 846150 admissions in both groups - OSA-D+ and OSA-D-.The OSA-D+ cohort often consisted of younger (median age, 64 vs 65); females (55.5% vs 55.2%) with both cohorts predominantly including white, Medicare enrollees. The OSA-D+ cohort had significantly higher rates (all p<0.001) of comorbidities such as Hypertension (68.6% vs 64.6%); Diabetes (48.4% vs 47.4%); Hyperlipidemia (59.2% vs 53.5%); Congestive Heart Failure (21.7% vs 20.6%); Peripheral Vascular Disease (6.7% vs 6.3%); Anemia (22.4% vs 19.7%); Smoking (44.6% vs 41.8%); Substance abuse, prior MI,TIA/Stroke and Venous Thromboembolism compared to the OSA-D- group. Paradoxically, there was decreased all-cause mortality (OR:0.79, 95%CI 0.73-0.86), major adverse cardiac and cerebrovascular events (OR:0.83, 95%CI 0.80-0.87), acute MI (OR:0.80, 95%CI 0.76-0.85), dysrhythmia/AF (OR:0.81, 95%CI 0.79-0.83) and cardiac arrest including VF (OR:0.65, 95%CI 0.73-0.82) in the OSA-D+ cohort cohort during hospitalization (p<0.001). Conclusion: Despite having more comorbidities, OSA patients with depression were found to have better in-hospital outcomes. Further studies are required for a conclusive reason for this paradoxical effect of co-morbid depression.