Article Figures & Data
Figures
- Figure 1
Flow diagram summarizing the process of enrollment and follow-up.
- Figure 2
Cumulative incidence of panic disorder in patients with sleep apnea and the matched cohort.
Tables
Characteristics Sleep Apnea (n = 8,704) Controls (n = 34,792) P Value Mean age, y (SD) 47.9 (15.1) 47.9 (15.1) .963 Male, No. (%) 5,490 (63.07) 21,943 (63.07) .993 Monthly income, No. (%) >.999 Dependent 1,539 (17.68) 6,156 (17.69) NT$0-NT$19,100a 2,001 (22.99) 8,002 (23.00) NT$19,100-NT$42,000a 3,713 (42.66) 14,852 (42.69) >NT$42,000a 1,451 (16.67) 5,782 (16.62) Urbanization, No. (%) 1.000 Level 1 (highest) 5,188 (59.60) 20,750 (59.64) Level 2 2,901 (33.33) 11,598 (33.33) Level 3 503 (5.78) 2,003 (5.76) Level 4 (lowest) 112 (1.29) 441 (1.27) Charlson comorbidity score, No. (%) <.001 0 1,982 (22.77) 14,216 (40.86) 1 2,074 (23.83) 8,323 (23.92) 2 1,561 (17.93) 4,919 (14.14) 3 1,108 (12.73) 2,822 (8.11) ≥4 1,979 (22.74) 4,512 (12.97) Outpatient visits in the past 1 year, No. (%) <.001 0–5 122 (1.40) 2,854 (8.21) 6–10 1,110 (12.75) 8,608 (24.74) 11–15 1,342 (15.42) 6,946 (19.96) >15 6,130 (70.43) 16,384 (47.09) Comorbid disease, No. (%) Hypertension 3,429 (39.40) 9,204 (26.45) <.001 Coronary artery disease 2,198 (25.25) 4,992 (14.35) <.001 Cerebrovascular disease 1,254 (14.41) 2,964 (8.52) <.001 Asthma 1,604 (18.43) 3,721 (10.69) <.001 COPD 2,392 (27.48) 5,695 (16.37) <.001 Chronic kidney disease 902 (10.36) 2,227 (6.40) <.001 Dyslipidemia 2,923 (33.58) 7,271 (20.90) <.001 Paralysis 130 (1.49) 353 (1.01) <.001 Irritable bowel syndrome 1,476 (16.96) 3,405 (9.79) <.001 Mitral valve prolapse 505 (5.80) 1,072 (3.08) <.001 Premenstrual syndrome 57 (0.65) 132 (0.38) <.001 Hyperthyroidism 464 (5.33) 1,081 (3.11) <.001 Diabetes mellitus 1,831 (21.04) 5,290 (15.20) <.001 Drug abuse 332 (3.81) 742 (2.13) <.001 Cancer 819 (9.41) 2,064 (5.93) <.001 Bipolar disorder 31 (0.36) 60 (0.17) .001 Obsessive-compulsive disorder 44 (0.51) 57 0.16) <.001 Depression 384 (4.41) 590 (1.70) <.001 Phobia 23 (0.26) 37 (0.11) <.001 PTSD 9 (0.10) 7 (0.02) <.001 ↵a NT$1 = US$0.033.
COPD = chronic obstructive pulmonary disease; PTSD = post-traumatic stress disorder.
- Table 2
Serial Multivariate Adjustment Showing Sleep Apnea as a Risk Factor for Incident Panic Disorder
Adjustment Model Hazard Ratio 95% CI P Value Crude, unadjusted 3.16 2.47–4.02 <.001 Model 1a 3.17 2.48–4.04 <.001 Model 2b 2.62 2.04–3.37 <.001 Model 3c 2.47 1.92–3.17 <.001 Model 4d 2.21 1.71–2.86 <.001 Model 5e 2.17 1.68–2.81 <.001 ↵a Adjusted for age, sex.
↵b Adjusted for age, sex, monthly income, urbanization, outpatient visits.
↵c Adjusted for variables in Model 2 plus psychiatric comorbidities.
↵d Adjusted for variables in Model 2 plus all comorbidities in Table 1.
↵e Adjusted for variables in Model 4 plus Charlson comorbidity score.
Supplemental Appendix
Supplemental Figure 3. HRs of sleep apnea for risk of incident panic disorder in subgroup analysis. Supplemental Figure 4. HRs of sleep apnea for risk of incident panic disorder in subgroup analysis.
Files in this Data Supplement:
- Supplemental data: Appendix - PDF file
The Article in Brief
Sleep Apnea and Risk of Panic Disorder
Kun-Ta Chou , and colleagues
Background Obstructive sleep apnea occurs when the throat muscles relax and block the airway during sleep. It has been linked to depression and other mental health issues. This study examines the relationship between sleep apnea and panic disorder.
What This Study Found Sleep apnea more than doubles the risk of developing panic disorder. Analysis of data from 8,704 sleep apnea patients and 34,792 control patients from the Taiwan National Health Insurance Research Database revealed that of the 43,496 patients, 263 (0.60 percent) suffered from panic disorder during a nearly 4-year follow-up period, including 117 (1.34 percent) from the sleep apnea cohort and 146 (0.42 percent) from the control group. There may be several explanations for the link between sleep apnea and panic disorder.
Implications
- The authors advise clinicians to be aware of possible panic disorder in sleep apnea patients.
