Prevalence and impact of comorbid mental disorders in hospitalized patients with obstructive sleep apnea (OSA): a nationwide study using administrative data

Abstract

Study Objectives: To compare the prevalence of mental comorbidities between hospitalization episodes with and without obstructive sleep apnea (OSA) and analyze their association with risk factors and negative outcomes. Methods: An observational retrospective study was conducted using an administrative database of discharges from all Portuguese mainland public hospitals. All-cause adult hospitalizations occurring between 2008-2015 were dichotomized according to the existence of an OSA code (ICD-9-CM 327.23). Mental disorders were clustered into categories 650-670 of Clinical Classifications Software. Within the OSA group, binary logistic regressions were performed to analyze associations between mental comorbidities and modifiable OSA risk factors and hospitalization outcomes. Results: Of 6 072 538 admissions, 36 385 had a primary or secondary diagnosis of OSA, which was associated with higher odds of concurrent anxiety disorders (adjusted odds ratio [aOR] = 1.84), bipolar disorders (aOR = 2.68), depressive disorders (aOR = 2.38), alcohol abuse (aOR = 1.29) and suicidal behaviors (aOR = 1.52) compared to those without OSA (all p < 0.05). Each of these mental comorbidities was associated with greater odds of at least two OSA risk factors (obesity, smoking, alcohol abuse and/or opioid/sedative abuse). Depression and alcohol abuse were associated with longer hospital stay (aOR = 1.26 and 1.13, p < 0.05), and depression increased the odds of 90-day all-cause readmissions (aOR = 1.20, 95% CI: 1.07-1.34). No associations were found with in-hospital mortality. Conclusions: These findings emphasize the complex interplay between OSA and mental disorders, suggesting relevant bidirectional relationships, and highlighting the importance of comprehensive assessment and management of mental health in individuals with OSA.