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Risk of obstructive sleep apnea in patients with bipolar disorder: A nationwide population‐based cohort study in Taiwan
Author(s) -
Chang EnTing,
Chen ShihFen,
Chiang JenHuai,
Wang LingYi,
Hsu ChungY,
Shen YuChih
Publication year - 2019
Publication title -
psychiatry and clinical neurosciences
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.609
H-Index - 74
eISSN - 1440-1819
pISSN - 1323-1316
DOI - 10.1111/pcn.12802
Subject(s) - medicine , obstructive sleep apnea , hazard ratio , confidence interval , cohort study , cohort , proportional hazards model , sleep apnea , odds ratio , bipolar disorder , population , pediatrics , environmental health , lithium (medication)
Aim Previous studies have found a high prevalence of risk factors for obstructive sleep apnea (OSA) in patients with bipolar disorder (BD). This study aimed to determine whether BD patients are associated with an increased risk of incident OSA. Methods Using the National Health Insurance Research Database of Taiwan, 3650 BD patients and 18 250 non‐BD controls matched by sex and age were enrolled between 2000 and 2010 and followed until the end of 2013. Patients who developed OSA confirmed by a polysomnographic examination during the follow‐up period were identified. Cox regression analysis was performed to examine the risk of OSA between BD patients and comparative controls. Results BD patients were prone to developing OSA in the crude analysis (hazard ratio [HR]: 1.63, 95% confidence interval [CI]: 1.07–2.49). After adjusting for demographics and comorbidities, the HR declined and was only marginally significant (HR: 1.54, 95%CI: 0.99–2.37). The stratification analysis by sex revealed that the risk trend with BD and subsequent OSA was mainly contributed by male BD patients (HR: 1.72, 95%CI: 1.02–2.91) and female BD patients weakened the overall association. Additionally, this study found that older age, higher income, living in urbanized areas, and some metabolic comorbidities were potential risk factors for developing OSA. Conclusion This study shows that male BD patients are associated with an increased risk of OSA, which has direct implications for the development of targeted prevention interventions or the implementation of a screening algorithm for OSA to reduce its negative health impact.