Sleep Apnea and Risk of Panic Disorder

Abstract

PURPOSE Epidemiological studies have identified a trend in the development of depressive and anxiety disorders following a diagnosis of sleep apnea. The relationship between sleep apnea and subsequent panic disorder, however, remains unclear.METHODS Using a nationwide database, the Taiwan National Health Insurance Research Database, patients with sleep apnea and age-, sex-, income-, and urbanization-matched control patients who did not have sleep apnea were enrolled between 2000 and 2010. Patients with a prior diagnosis of panic disorder before enrollment were excluded. The 2 cohorts were observed until December 31, 2010. The primary endpoint was occurrence of newly diagnosed panic disorder.RESULTS A total of 8,704 sleep apnea patients and 34,792 control patients were enrolled. Of the 43,496 patients, 263 (0.60%) suffered from panic disorder during a mean follow-up period of 3.92 years, including 117 (1.34%) from the sleep apnea cohort and 146 (0.42%) from the control group. The Kaplan-Meier analysis revealed a predisposition of patients with sleep apnea to develop panic disorder (log-rank test, P <.001). After multivariate adjustment, the hazard ratio for subsequent panic disorder among the sleep apnea patients was 2.17 (95% confidence interval, 1.68-2.81; P <.001).CONCLUSIONS Sleep apnea appears to confer a higher risk for future development of panic disorder. INTRODUCTIONO bstructive sleep apnea is a common disorder characterized by repeated episodes of apnea and hypopnea during sleep owing to complete or partial collapse of the upper airway.1 Subsequent to apnea/hypopnea, patients with sleep apnea will be awakened by the resulting hypoxemia so that they can resume breathing. Some patients may awake up feeling like they are choking or suffocating, thereby increasing their sense of stress. In the past decade obstructive sleep apnea has been found to be linked to a variety of cardiovascular diseases, neurocognitive dysfunction, and behavioral disorders. 2,3Patients with sleep apnea may also have substantial comorbid mental disorders, such as depression, anxiety, bipolar disorder, schizophrenia, post-traumatic stress syndrome, and substance abuse. 4 Panic disorder is an extreme pole of anxiety disorder with features of recurrent panic attacks. There are, however, few studies addressing the relationship between sleep apnea and panic disorder, and most of these studies are small or lack an appropriate control group.5-9 A crossover study enrolling 12 patients with panic disorder who also had obstructive sleep apnea showed that they benefited from continuous positive airway pressure (CPAP) therapy, which decreased the panic attacks and reduced the use of alprazolam, suggesting an interaction of both diseases. 10 We therefore undertook this nationwide population-based study to elucidate the relationship of sleep apnea and subsequent panic disorder. 11 The data used in this study were retrieved from the Longitudinal Health Insurance Database 2000 (LHID2000), comprised of approximately 1,000,000 randomly sampl...

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