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Volume 09 No. 12
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Scientific Investigations

The Comorbidity of Sleep Apnea and Mood, Anxiety, and Substance Use Disorders among Obese Military Veterans within the Veterans Health Administration

http://dx.doi.org/10.5664/jcsm.3262

Kimberly A. Babson, Ph.D.1,2; A. C. Del Re, Ph.D.1,2; Marcel O. Bonn-Miller, Ph.D.1,3,4,5; Steven H. Woodward, Ph.D.3
1Center for Health Care Evaluation, VA Palo Alto Health Care System, Menlo Park, CA; 2Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA; 3National Center for PTSD, VA Palo Alto Health Care System, Menlo Park, CA; 4Center of Excellence in Substance Abuse Treatment and Education, Philadelphia VAMC, Philadelphia, PA; 5Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA

Objectives:

To determine the relations between obstructive sleep apnea (OSA) diagnosis, the likelihood of being diagnosed with a psychological condition, among obese veterans, after accounting for severity of obesity and the correlated nature of patients within facility. We hypothesized that (1) individuals with a diagnosis of OSA would be more likely to receive a diagnosis of a (a) mood disorder and (b) anxiety disorder, but not (c) substance use disorder.

Design:

Cross-sectional retrospective database review of outpatient medical records between October 2009 and September 2010, conducted across all 140 Veterans Health Administration (VHA) facilities.

Setting:

The entire VA Health Care System.

Patients or Participants:

Population-based sample of veterans with obesity (N = 2,485,658).

Main Outcome Measures:

Physician- or psychologist-determined diagnosis of psychological conditions including mood, anxiety, and substance use disorders.

Results:

Using generalized linear mixed modeling, after accounting for the correlated nature of patients within facility and the severity of obesity, individuals with a diagnosis of sleep apnea had increased odds of receiving a mood disorder diagnosis (OR = 1.85; CI = 1.71-1.72; p < 0.001), anxiety disorder diagnosis (OR = 1.82; CI = 1.77-1.84; p < 0.001), but not a diagnosis of substance use disorder.

Conclusions:

Among obese veterans within VA, OSA is associated with increased risk for having a mood and anxiety disorder, but not substance use disorder, with the strongest associations observed for posttraumatic stress disorder (PTSD) and major depressive disorder (MDD). In addition, this relation remained after accounting for severity of BMI.

Citation:

Babson KA; Del Re AC; Bonn-Miller MO; Woodward SH. The comorbidity of sleep apnea and mood, anxiety, and substance use disorders among obese military veterans within the Veterans Health Administration. J Clin Sleep Med 2013;9(12):1253-1258.




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