Occult, undiagnosed obstructive sleep apnea increases risk of depression among a national sample of older adult Medicare beneficiaries

Abstract

Study objectivesTo determine the association between occult, undiagnosed obstructive sleep apnea and incident depression among a nationally representative sample of older adult Medicare beneficiaries. MethodsOur data source was a random 5% sample of Medicare administrative claims data for the years 2006-2013. Occult, undiagnosed obstructive sleep apnea was defined as the 12-month period preceding receipt of one or more International Classification of Disease, Version 9, Clinical Modification diagnostic codes for obstructive sleep apnea. To determine the effect of obstructive sleep apnea on incident depression, beneficiaries with undiagnosed obstructive sleep apnea were matched on index date to a random sample of nonsleep disordered controls (ie, individuals without evidence of sleep-related testing, diagnosis, or treatment). After excluding beneficiaries with preexisting depression, the risk of depression was modeled as a function of occult, undiagnosed obstructive sleep apnea status over the 12months prior to obstructive sleep apnea diagnosis using log-binomial regression. Covariates were balanced between groups using inverse probability of treatment weights. ResultsThe final sample included 21,116 beneficiaries with occult, undiagnosed obstructive sleep apnea and 237,375 nonsleep disordered controls. In adjusted models, beneficiaries with occult, undiagnosed obstructive sleep apnea demonstrated a significantly higher risk of depression during the year prior to obstructive sleep apnea diagnosis (risk ratio 3.19; 95% confidence interval 3.00, 3.39). ConclusionsIn this national study of Medicare beneficiaries and relative to nonsleep disordered controls, occult, undiagnosed obstructive sleep apnea was associated with a significantly higher risk for incident depression.