Depression Paradox in Cardiovascular Outcomes of Adult Patients with Obstructive Sleep Apnea: Insights from 2 Million Nationwide Hospitalizations
OBJECTIVE: Depression is a frequent comorbidity in obstructive sleep apnea (OSA) patients. There is a scarcity of data on the impact of depression on the outcomes of OSA. MATERIAL AND METHODS: Using the National Inpatient Sample (2018), we identified hospitalizations in the US with OSA. Following p...
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2025-03-01
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| Online Access: | https://thoracrespract.org/articles/depression-paradox-in-cardiovascular-outcomes-of-adult-patients-with-obstructive-sleep-apnea-insights-from-2-million-nationwide-hospitalizations/doi/ThoracResPract.2024.23132 |
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| author | Rupak Desai Sashwath Srikanth Shaylika Chauhan Zainab Gandhi Warda Shahnawaz Aleen Rahman Bisharah Rizvi Akhil Jain |
| author_facet | Rupak Desai Sashwath Srikanth Shaylika Chauhan Zainab Gandhi Warda Shahnawaz Aleen Rahman Bisharah Rizvi Akhil Jain |
| author_sort | Rupak Desai |
| collection | DOAJ |
| description | OBJECTIVE: Depression is a frequent comorbidity in obstructive sleep apnea (OSA) patients. There is a scarcity of data on the impact of depression on the outcomes of OSA.
MATERIAL AND METHODS: Using the National Inpatient Sample (2018), we identified hospitalizations in the US with OSA. Following propensity-score matching, the two cohorts of OSA with depression (OSA+D+) vs. without depression (OSA+D-) were compared for demographic and comorbidities profiles differences. Multivariable regression analyses were performed to assess the odds of events with depression versus those without.
RESULTS: Of 2,169.730 hospitalizations in patients with OSA, 20.1% had comorbid depression. Matched cohorts included 846,150 admissions in both groups: OSA+D+ and OSA+D-. Both cohorts predominantly comprised Caucasians, the elderly (median age, 64 vs. 65 years), and females (55.5% vs. 55.2%). OSA+D+ cohort had a higher prevalence of hypertension, diabetes, hyperlipidemia, congestive heart failure, anemia, smoking, substance abuse, prior myocardial infarction (MI), transient ischemic attack (TIA), TIA/stroke, and venous thromboembolism than the OSA+D- group (all P < 0.001). Paradoxically, there was decreased risk of all-cause mortality [odds ratios (OR): 0.79, 95% confidence interval (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/atrial fibrillation (OR: 0.81, 95% CI: 0.79-0.83), and cardiac arrest including ventricular fibrillation (OR: 0.65, 95% CI: 0.73-0.82) in the OSA+D+ cohort (P < 0.001).
CONCLUSION: OSA+D+ patients had better in-hospital outcomes as compared to OSA+D- despite having a higher burden of comorbidities. Additional research is warranted to validate this paradoxical effect of depression in OSA. |
| format | Article |
| id | doaj-art-73534c94289a41a7898305647b29f98d |
| institution | Kabale University |
| issn | 2979-9139 |
| language | English |
| publishDate | 2025-03-01 |
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| series | Thoracic Research and Practice |
| spelling | doaj-art-73534c94289a41a7898305647b29f98d2025-02-05T06:06:35ZengAVESThoracic Research and Practice2979-91392025-03-01262434710.4274/ThoracResPract.2024.23132Depression Paradox in Cardiovascular Outcomes of Adult Patients with Obstructive Sleep Apnea: Insights from 2 Million Nationwide HospitalizationsRupak Desai0https://orcid.org/0000-0002-5315-6426Sashwath Srikanth1https://orcid.org/0000-0002-6946-4570Shaylika Chauhan2https://orcid.org/0000-0002-0253-3973Zainab Gandhi3https://orcid.org/0000-0002-7214-4981Warda Shahnawaz4https://orcid.org/0009-0006-3874-3776Aleen Rahman5https://orcid.org/0009-0002-7733-8395Bisharah Rizvi6https://orcid.org/0000-0002-4008-1699Akhil Jain7https://orcid.org/0000-0001-7298-4246Independent Researcher, Georgia, USADepartment of Internal Medicine, East Carolina University (ECU) Health, North Carolina, USADepartment of Internal Medicine, Geisinger Wyoming Valley Medical Center, Pennsylvania, USADepartment of Internal Medicine, Geisinger Wyoming Valley Medical Center, Pennsylvania, USADepartment of Internal Medicine, Jinnah Postgraduate Medical Centre, Karachi, PakistanDepartment of Internal Medicine, Fatima Jinnah Med University, Lahore, PakistanDepartment of Pulmonary Medicine, Integra Health, California, USADepartment of Internal Medicine, Mercy Catholic Medical Center, Pennsylvania, USAOBJECTIVE: Depression is a frequent comorbidity in obstructive sleep apnea (OSA) patients. There is a scarcity of data on the impact of depression on the outcomes of OSA. MATERIAL AND METHODS: Using the National Inpatient Sample (2018), we identified hospitalizations in the US with OSA. Following propensity-score matching, the two cohorts of OSA with depression (OSA+D+) vs. without depression (OSA+D-) were compared for demographic and comorbidities profiles differences. Multivariable regression analyses were performed to assess the odds of events with depression versus those without. RESULTS: Of 2,169.730 hospitalizations in patients with OSA, 20.1% had comorbid depression. Matched cohorts included 846,150 admissions in both groups: OSA+D+ and OSA+D-. Both cohorts predominantly comprised Caucasians, the elderly (median age, 64 vs. 65 years), and females (55.5% vs. 55.2%). OSA+D+ cohort had a higher prevalence of hypertension, diabetes, hyperlipidemia, congestive heart failure, anemia, smoking, substance abuse, prior myocardial infarction (MI), transient ischemic attack (TIA), TIA/stroke, and venous thromboembolism than the OSA+D- group (all P < 0.001). Paradoxically, there was decreased risk of all-cause mortality [odds ratios (OR): 0.79, 95% confidence interval (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/atrial fibrillation (OR: 0.81, 95% CI: 0.79-0.83), and cardiac arrest including ventricular fibrillation (OR: 0.65, 95% CI: 0.73-0.82) in the OSA+D+ cohort (P < 0.001). CONCLUSION: OSA+D+ patients had better in-hospital outcomes as compared to OSA+D- despite having a higher burden of comorbidities. Additional research is warranted to validate this paradoxical effect of depression in OSA.https://thoracrespract.org/articles/depression-paradox-in-cardiovascular-outcomes-of-adult-patients-with-obstructive-sleep-apnea-insights-from-2-million-nationwide-hospitalizations/doi/ThoracResPract.2024.23132obstructive sleep apneasleep-disordered breathingdepressionmortality myocardial infarctioncardiac arreststroke |
| spellingShingle | Rupak Desai Sashwath Srikanth Shaylika Chauhan Zainab Gandhi Warda Shahnawaz Aleen Rahman Bisharah Rizvi Akhil Jain Depression Paradox in Cardiovascular Outcomes of Adult Patients with Obstructive Sleep Apnea: Insights from 2 Million Nationwide Hospitalizations Thoracic Research and Practice obstructive sleep apnea sleep-disordered breathing depression mortality myocardial infarction cardiac arrest stroke |
| title | Depression Paradox in Cardiovascular Outcomes of Adult Patients with Obstructive Sleep Apnea: Insights from 2 Million Nationwide Hospitalizations |
| title_full | Depression Paradox in Cardiovascular Outcomes of Adult Patients with Obstructive Sleep Apnea: Insights from 2 Million Nationwide Hospitalizations |
| title_fullStr | Depression Paradox in Cardiovascular Outcomes of Adult Patients with Obstructive Sleep Apnea: Insights from 2 Million Nationwide Hospitalizations |
| title_full_unstemmed | Depression Paradox in Cardiovascular Outcomes of Adult Patients with Obstructive Sleep Apnea: Insights from 2 Million Nationwide Hospitalizations |
| title_short | Depression Paradox in Cardiovascular Outcomes of Adult Patients with Obstructive Sleep Apnea: Insights from 2 Million Nationwide Hospitalizations |
| title_sort | depression paradox in cardiovascular outcomes of adult patients with obstructive sleep apnea insights from 2 million nationwide hospitalizations |
| topic | obstructive sleep apnea sleep-disordered breathing depression mortality myocardial infarction cardiac arrest stroke |
| url | https://thoracrespract.org/articles/depression-paradox-in-cardiovascular-outcomes-of-adult-patients-with-obstructive-sleep-apnea-insights-from-2-million-nationwide-hospitalizations/doi/ThoracResPract.2024.23132 |
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