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

Figures & data

Figure 1 Study flowchart. CPAP indicates continuous positive airway pressure; MI, myocardial infarction.

Table 1 General Characteristics of Study Subjects According to Depression

	Total(n=1106)	Depression(n=133)	Non-Depression (n=973)	P-value
Age, (y)	66.0(62.0, 71.0)	70.0(65.5, 76.0)	65.0(62.0, 70.0)	0.000
Male(n,%)	686(62.0)	85(63.9)	601(61.8)	0.633
BMI(kg/m^2)	26.0(23.8, 28.4)	26.5(23.6, 30.0)	26.0(23.8, 28.2)	0.163
AHI(events/h)	25.4(14.5, 40.7)	30.9(17.2, 50.9)	24.5(14.1, 39.7)	0.006
ODI(events/h)	20.0(10.1, 36.3)	24.1(13.2, 43.5)	19.4(10.0, 36.0)	0.001
Average apnea time(s)	22.3(19.4, 25.3)	23.0(19.5, 26.6)	22.1(19.4, 25.1)	0.077
Maximum apnea time(s)	50.0(33.0, 74.1)	61.8(42.0, 88.0)	48.0(32.0, 71.0)	0.000
MSaO2(%)	93.5(92.0, 95.0)	92.2(90.0, 94.0)	94.0(92.0, 95.0)	0.000
LSaO2(%)	81.0(73.0, 85.0)	78.0(67.5, 83.0)	81.0(74.0, 86.0)	0.000
TSA90(min)	12.7(2.0, 53.8)	14.9(2.5, 101.4)	12.0(2.0, 49.1)	0.158
Average heart Rate(events/min)	63.0(57.8, 69.0)	62.0(57.0, 68.0)	63.4(57.9, 69.0)	0.434
SBP, mmHg	130.0(122.0, 145.0)	140.0(128.0, 160.0)	130.0(121.0, 140.0)	0.000
DBP, mmHg	76.0(70.0, 82.0)	76.0(70.0, 84.0)	76.0(70.0, 82.0)	0.695
WC, mm	89.0(79.0, 99.0)	88.0(78.0, 101.5)	89.0(80.0, 99.0)	0.485
TG, mmol/L	1.4(1.0, 1.9)	1.4(1.0, 1.9)	1.4(1.0, 1.9)	0.692
HDL, mmol/L	1.1(0.9, 1.3)	1.1(0.9, 1.3)	1.1(0.9, 1.3)	0.820
Glu, mmol/L	5.7(5.1, 6.5)	5.8(5.0, 6.9)	5.6(5.1, 6.4)	0.201
Creatinine, mmol/L	72.3(62.3, 83.7)	76.1(65.2, 95.8)	72.0(61.9, 82.9)	0.003
Uric acid, mmol/L	342.0(300.0, 391.0)	363.0(313.3, 406.8)	340.0(297.8, 390.0)	0.012
Smoking(n,%)	248(22.5)	42(32.3)	206(21.2)	0.004
Drinking(n,%)	133(12.1)	24(18.5)	109(11.2)	0.017
Medical history(n,%)
Hyperlipidemia (n,%)	299(27.0)	29(21.8)	270(27.7)	0.148
AF(n,%)	96(8.7)	16(12.0)	80(8.2)	0.001
CHD(n,%)	255(23.1)	42(31.6)	213(21.9)	0.013
COPD(n,%)	76(6.9)	18(13.5)	58(6.0)	0.001
Carotid atherosclerosis(n,%)	284(25.7)	46(34.6)	238(24.5)	0.012
Hypertension(n,%)	699(63.2)	98(73.7)	601(61.8)	0.008
Cardiac dysfunction(n,%)	72(6.5)	13(9.8)	59(6.1)	0.104
Renal dysfunction(n,%)	39(3.5)	13(9.8)	26(2.7)	0.000
Cerebrovascular disease (n,%)	190(17.2)	39(29.3)	151(15.5)	0.000

Abbreviations: BMI, body mass index; AHI, the apnea-hypopnea index; ODI, the oxygen desaturation index; MSpO2, the mean pulse oxygen saturation; LSpO2, the lowest pulse oxygen saturation; TSA90, the duration of time with SaO2 <90%; WC, waist circumference; SBP, systolic blood pressure; DBP, diastolic blood pressure; TG, triglyceride; HDL, high-density lipoprotein; CHD, coronary heart disease; AF, atrial fibrillation; COPD, chronic obstructive pulmonary disease.

Table 2 Crude Number of Adverse Events During Follow-Up

Follow-Up Outcomes	Total (n=1106)	Depression (n=133)	Non-Depression (n=973)	P-value
MACE(n,%)	96 (9.6)	25 (21.6)	71 (8.0)	0.000
Cardiovascular death(n,%)	20 (2.0)	6 (5.2)	14 (1.6)	0.010
MI(n,%)	30 (3.0)	10 (8.5)	20 (2.3)	0.000
Hospitalization for unstable angina(n,%)	50 (5.0)	15 (12.7)	35 (4.0)	0.000
Hospitalization for heart failure(n,%)	9(2.9)	3(2.6)	6(0.7)	0.042

Table 3 Association Between Depression and Incidence of All Events

Follow-up outcomes	Unadjusted Analysis		Adjusted Analysis
	HR(95% CI)	P-value	HR(95% CI)	P-value
MACE(n,%)	2.63(1.66, 4.14)	0.000	2.29(1.34, 3.90)	0.002
Cardiovascular death(n,%)	3.86(1.26, 11.81)	0.018	2.42(0.79, 7.45)	0.124
MI(n,%)	2.97(1.28, 6.89)	0.011	2.27(0.95, 5.45)	0.066
Hospitalization for unstable angina(n,%)	4.77(2.42, 9.38)	0.000	3.70(1.73, 7.93)	0.001
Hospitalization for heart failure(n,%)	4.02(0.96, 16.85)	0.057	2.09(0.25, 17.63)	0.496

Figure 2 Kaplan-Meier curve of depression group and non- depression group on the risk of MACE. 0: non-depression group, 1: depression group, Log Rank P< 0.000.

Table 4 The Interaction Between AHI and Depression on the Risk of MACE

Variables	Model 1 P	Model 2 P	Model 3 P
Total population(n=1106)	0.186	0.174	0.166
Hypertension population(n=699)	0.020	0.024	0.027
Non-hypertension population(n=407)	0.742	0.679	0.561
Carotid atherosclerosis population(n=284)	0.255	0.201	0.191
Non-carotid atherosclerosis population (n=822)	0.536	0.500	0.310
COPD population(n=76)	0.877	0.845	0.824
Non-COPD population(n=1030)	0.106	0.095	0.080
Male(n=686)	0.197	0.166	0.130
Female(n=420)	0.901	0.908	0.935
≥70(n=355)	0.144	0.189	0.204
<70(n=751)	0.213	0.186	0.154

Notes: Model 1: unadjusted. Model 2: adjusted depression, age, AHI, ODI, Maximum apnea time, MSaO2, LSaO2, hypertension, CHD, Cerebrovascular disease, carotid atherosclerosis, AF, COPD, renal dysfunction, smoking, and alcohol use. Model 3: adjusted depression, age, AHI, ODI, Maximum apnea time, MSaO2, LSaO2, creatinine, uric acid, hypertension, CHD, Cerebrovascular disease, carotid atherosclerosis, AF, COPD, renal dysfunction, smoking, and alcohol use.

Table 5 Subgroup Analysis of the Associations Between Depression and MACE

	Unadjusted Analysis		Adjusted Analysis		Interaction
	HR(95% CI)	P-value	HR(95% CI)	P-value	P-value
Gender					0.422
Male	3.14(1.82, 5.40)	0.000	2.96(1.52, 5.77)	0.001
Female	1.83(0.78, 4.27)	0.163	1.18(0.40, 3.48)	0.760
Age					0.498
<70	1.65(0.78, 3.51)	0.194	1.72(0.70, 4.25)	0.238
≥70	3.08(1.66, 5.70)	0.000	3.39(1.57, 7.28)	0.002
Severity of OSA					0.407
Mild	1.26(0.37, 4.23)	0.713	0.90(0.18, 4.40)	0.891
Moderate-Severe	3.15(1.91, 5.21)	0.000	2.82(1.55, 5.14)	0.001
BMI					0.424
Overweight-Obese	2.30(1.29, 4.12)	0.005	2.98(1.49, 6.00)	0.002
Normal	3.43(1.63, 7.21)	0.001	2.70(1.03, 7.08)	0.043