Association of Depression with Long-Term Cardiovascular Risks in Older Patients with Obstructive Sleep Apnea

Zhe Zhao; Yinghui Gao; Junling Lin; Ruyi Xu; Zijun He; Libo Zhao; Fengfeng Fang; Weimeng Cai; Kaibin Chen; Li Fan; Lin Liu

doi:10.2147/NSS.S423550

Association of Depression with Long-Term Cardiovascular Risks in Older Patients with Obstructive Sleep Apnea

Nat Sci Sleep. 2023 Dec 5:15:1033-1043. doi: 10.2147/NSS.S423550. eCollection 2023.

Authors

Zhe Zhao^#¹, Yinghui Gao^#², Junling Lin^#³, Ruyi Xu⁴, Zijun He⁵, Libo Zhao¹, Fengfeng Fang⁵, Weimeng Cai⁶, Kaibin Chen⁷, Li Fan¹, Lin Liu⁶

Affiliations

¹ Cardiology Department of the Second Medical Center & National Clinical Research Center for Geriatric Diseases, Chinese PLA General Hospital, Beijing, People's Republic of China.
² PKU-Upenn Sleep Center, Peking University International Hospital, Beijing, People's Republic of China.
³ Department of Pulmonary and Critical Care Medicine, Beijing Chaoyang Hospital Affiliated to Capital Medical University, Beijing, People's Republic of China.
⁴ Sixth Medical Center, Chinese PLA General Hospital, Beijing, People's Republic of China.
⁵ Medical College, Yan'an University, Yan'an, People's Republic of China.
⁶ Department of Respiratory and Critical Care Medicine of the Second Medical Center & National Clinical Research Center for Geriatric Diseases, Chinese PLA General Hospital, Beijing, People's Republic of China.
⁷ Sleep Center, The Affiliated Hospital of Gansu University of Chinese Medicine, Lanzhou City, People's Republic of China.

^# Contributed equally.

Abstract

Introduction: Obstructive sleep apnea (OSA) is associated with an increased risk of cardiovascular disease (CVD). Depression is a crucial factor among the various factors that are associated with OSA and CVD.

Purpose: This study was conducted with an aim to assess the prognostic significance of depression on the MACE in older patients with OSA.

Patients and methods: 1106 older patients with OSA, without myocardial infarction (MI), history of hospitalization for unstable angina, or heart failure at baseline were enrolled and followed up prospectively. Incidence rates were expressed as cumulative incidence. Cox proportional hazards analysis was used to estimate the risk of all events. The primary outcomes were major adverse cardiovascular events (MACE). Each patient underwent polysomnography (PSG) and GDS-12 scale assessment. Those with an apnea-hypopnea index (AHI) greater than 5 were diagnosed with OSA, while those with a scale score greater than 3 were diagnosed with depression.

Results: Among the 1106 older patients with OSA, depression was found in 133(12.0%) patients, 96(8.7%) patients experienced MACE during the follow-up. Depression was associated with a higher cumulative incidence of MACE in older patients with OSA. Multivariate analysis revealed that depression independently increased the risk of MACE (adjusted hazard ratio [aHR] = 2.29; 95% confidence interval [CI]: 1.34-3.90; P = 0.002). Subgroup analyses showed that male patients (aHR = 2.96; 95% CI: 1.52-5.77; P = 0.001), overweight-obese individuals (aHR = 2.98; 95% CI: 1.49-6.00; P = 0.002), and those with moderate-severe OSA (aHR = 2.82; 95% CI: 1.55-5.14; P = 0.001) and concurrent depression were at a higher risk for MACE.

Conclusion: Depression is common in older patients with OSA in the absence of MI, hospitalization for unstable angina, or heart failure, and confers an independent, increased risk of MACE.

Keywords: MACE; OSA; depression; major adverse cardiovascular events; obstructive sleep apnea; older adults.

Grants and funding

Master reports a grant from Army experimental animal special research project (SYDW_KY[2021]04), Military Health Care Project (23BJZ27, 22BJZ52, 19BJZ38) and Military Equipment Construction Application Research Project (LB20211A010013).