The prevalence and predictors of obstructive sleep apnea in major depressive disorder, bipolar disorder and schizophrenia: A systematic review and meta-analysis

Background Obstructive sleep apnea (OSA) is a health hazard since it is associated with neurocognitive dysfunction and cardio-metabolic diseases. The prevalence of OSA among people with serious mental illness (SMI) is unclear. Method We searched major electronic databases from inception till 06/2015. Articles were included that reported the prevalence of OSA determined by polysomnography (PSG) or an apnea-hypopnea index (AHI) >5 events/hr, in people with major depressive disorder (MDD), bipolar disorder (BD) or schizophrenia. A random effects meta-analysis calculating the pooled prevalence of OSA and meta-regression of potential moderators were performed. Results Twelve articles were included representing 570,121 participants with SMI (mean age=38.3 years (SD=7.5)), 45.8% male (range=32-80.4) and mean body mass index (BMI) 25.9 (SD=3.7). The prevalence of OSA in SMI in clinical studies was 25.7% (95% CI 13.9 to 42.4%, n=1,535). Higher frequencies of OSA were seen in MDD (36.3%, 19.4-57.4%, n=525) than in BD (24.5%, 95% CI 10.6-47.1, n=681) and schizophrenia (15.4%, 95% CI 5.3-37.1%, n=329). The prevalence of OSA in 568,586 people with SMI from population cohort studies was 10.7% (95% CI 2.4-37.0%) and 19.8% (95% CI 2.5-70.0%) in 358,853 people with MDD. Increasing age (β=0.063, 95% CI 0.0005-0.126, p=0.04, N=10) and BMI predicted increased prevalence of OSA (β=0.1642, 95% CI 0.004-0.3701, p=0.04, N=9). Conclusion People with SMI (particularly MDD) have a high prevalence of OSA. Screening for and interventions to manage OSA in SMI including those focused on reducing BMI are warranted. © 2016 Elsevier B.V. All rights reserved.