Age and sex differences on the association between anxiety disorders and obstructive sleep apnea: A nationwide case-control study in Taiwan

Tien-Yu Chen; Terry B J Kuo; Chi-Hsiang Chung; Nian-Sheng Tzeng; Hsiao-Ching Lai; Wu-Chien Chien; Cheryl C H Yang

doi:10.1111/pcn.13352

Age and sex differences on the association between anxiety disorders and obstructive sleep apnea: A nationwide case-control study in Taiwan

Psychiatry Clin Neurosci. 2022 Jun;76(6):251-259. doi: 10.1111/pcn.13352. Epub 2022 Apr 5.

Authors

Tien-Yu Chen^{1

2

3}, Terry B J Kuo^{1

3

4}, Chi-Hsiang Chung^{5

6

7}, Nian-Sheng Tzeng^{2

8}, Hsiao-Ching Lai², Wu-Chien Chien^{5

6

9}, Cheryl C H Yang^{1

3}

Affiliations

¹ Institute of Brain Science, National Yang Ming Chiao Tung University, Taipei, Taiwan.
² Department of Psychiatry, Tri-Service General Hospital, School of Medicine, National Defense Medical Center, Taipei, Taiwan.
³ Sleep Research Center, National Yang Ming Chiao Tung University, Taipei, Taiwan.
⁴ Clinical Research Center, Taoyuan Psychiatric Center, Ministry of Health and Welfare, Taoyuan, Taiwan.
⁵ Department of Medical Research, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan.
⁶ School of Public Health, National Defense Medical Center, Taipei, Taiwan.
⁷ Taiwanese Injury Prevention and Safety Promotion Association, Taipei, Taiwan.
⁸ Student Counseling Center, National Defense Medical Center, Taipei, Taiwan.
⁹ Graduate Institute of Life Sciences, National Defense Medical Center, Taipei, Taiwan.

PMID: 35297559
DOI: 10.1111/pcn.13352

Abstract

Aim: The aim of this study was to examine the association between anxiety disorders and obstructive sleep apnea (OSA).

Methods: This is a population-based, retrospective case-control study using Taiwan's nationwide database. We included patients with OSA aged ≥12 years, diagnosed according to the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) codes: 327 and 780. Each enrolled patient with OSA needed to undergo a polysomnography examination within 1 year pre- or post-OSA occurrence. Patients with OSA and controls were selected in a 1:4 ratio. Patients with anxiety disorders (ICD-9-CM code 300) were diagnosed by board-certified psychiatrists and required to visit the outpatient clinic at least three times per year. Multivariate logistic regression and interaction analyses were used to evaluate the objective association.

Results: This study enrolled 7987 and 31 948 participants with and without OSA, respectively. A significant difference in anxiety exposure was observed only pre-OSA diagnosis but not post-OSA diagnosis. Compared with patients without anxiety disorders: (i) those with anxiety disorders had an adjusted odds ratio (aOR) of ≈1.864 in OSA comorbidity (aOR = 1.864; 95% confidence interval [CI] = 1.337-2.405); and (ii) subgroup analysis showed a significant interaction that anxiety patients of male sex, aged 18 to 44 years, aged 45 to 64 years, and hypertension had a higher aOR in OSA comorbidity (aOR = 2.104 [95% CI = 1.436-2.589], aOR = 1.942 [95% CI = 1.390-2.503], aOR = 2.179 [95% CI = 1.564-2.811], and aOR = 2.092 [95% CI = 1.497-2.706], respectively).

Conclusion: The study revealed a higher ratio of previous anxiety exposure in patients with OSA. Compared with those without anxiety, anxiety patients of male sex, aged 18 to 64 years, and with hypertension had a higher risk of OSA comorbidity.

Keywords: National Health Insurance Research database; anxiety; obstructive sleep apnea.

MeSH terms

Anxiety Disorders / epidemiology
Case-Control Studies
Comorbidity
Female
Humans
Hypertension* / complications
Hypertension* / epidemiology
Male
Retrospective Studies
Risk Factors
Sex Characteristics
Sleep Apnea, Obstructive* / epidemiology
Taiwan / epidemiology

Abstract

MeSH terms

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