Abstract
This study aimed to compare the prevalence of mental comorbidities between hospitalization episodes with and without obstructive sleep apnea (OSA), and to analyze the association of those mental comorbidities with modifiable risk factors that may potentiate OSA. An observational retrospective analysis 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. Of 6 072 538 admissions, 36 385 had a primary or secondary diagnosis of OSA, which was associated with greater odds of comorbid 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 significantly greater odds of at least two of the four studied risk factors that may potentiate OSA (namely obesity, smoking, alcohol abuse and opioid/sedative abuse). These findings emphasize the complex interplay between OSA and mental disorders, suggesting relevant bidirectional relationships, and highlight the importance of comprehensive assessment and management of mental health in individuals with OSA.