Sleep and Breathing

, Volume 21, Issue 2, pp 243–253 | Cite as

Sleep apnea is associated with an increased risk of mood disorders: a population-based cohort study

  • Ming-Kun Lu
  • Hung-Pin Tan
  • I-Ning Tsai
  • Li-Chung Huang
  • Xin-Ming Liao
  • Sheng-Hsiang LinEmail author
Sleep Breathing Physiology and Disorders • Original Article



The symptoms of sleep apnea, such as sleep fragmentation and oxygen desaturation, might be risk factors for subsequent mood disorder (MD), but associations between sleep apnea and MD remain unclear. This nationwide population-based study thus aimed to identify the risk of MD in patients with vs. without sleep apnea.


This cohort study used data from the National Health Insurance database. In total, 5415 patients diagnosed with sleep apnea between 2000 and 2010 were evaluated, and 27,075 matched non-sleep apnea enrollees were included as a comparison cohort. All subjects were followed until 2011. The Cox proportional hazard ratio (HR) was used to investigate the relationship between MD and sleep apnea while controlling covariates and comorbidities of sleep apnea.


Of 5415, 154 patients with sleep apnea (2.84 %) were diagnosed with MD during the follow-up period in comparison with 306 of 27,075 individuals (1.13 %) without antecedent sleep apnea. After adjusting for the selected factors and comorbidities, we found that patients with sleep apnea were from 1.82- to 2.07-fold greater risk of MD than the comparisons. Of the three subcategories of MD (major depressive disorder, bipolar disorder, and unspecified MD), sleep apnea had the highest predisposing risk with respect to major depressive disorder (adjusted HR from 1.82 to 2.07) and bipolar disorder (adjusted HR from 2.15 to 3.24).


There is a greater likelihood of MD manifesting in patients with a history of sleep apnea. Health professionals are thus advised to carefully monitor the psychological impacts of sleep apnea.


Sleep apnea Mood disorder Nationwide population-based study Major depressive disorder Bipolar disorder 


Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

The study protocol was approved by the Chia-Yi Christian General Hospital Research Ethics Committee.


No funding was received for this research.

Supplementary material

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Supplementary Fig. 3 (DOCX 55 kb)
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Supplementary Table 1 (DOCX 37 kb)
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Supplementary Table 2 (DOCX 36 kb)
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Supplementary Table 3 (DOCX 36 kb)


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Copyright information

© Springer-Verlag Berlin Heidelberg 2016

Authors and Affiliations

  • Ming-Kun Lu
    • 1
    • 2
  • Hung-Pin Tan
    • 3
    • 4
    • 5
  • I-Ning Tsai
    • 6
  • Li-Chung Huang
    • 6
    • 7
    • 8
  • Xin-Ming Liao
    • 6
    • 9
  • Sheng-Hsiang Lin
    • 6
    • 10
    Email author
  1. 1.Department of HealthJianan Mental HospitalTainanTaiwan
  2. 2.Department of Applied Life Science and HealthChia Nan University of Pharmacy and ScienceTainanTaiwan
  3. 3.Department of PsychiatryKaohsiung Veterans General Hospital Tainan BranchTainanTaiwan
  4. 4.Department of Acupressure TechnologyChung Hwa University of Medical TechnologyTainanTaiwan
  5. 5.Department of Environmental and Occupational Health, College of MedicineNational Cheng Kung UniversityTainanTaiwan
  6. 6.Institute of Clinical Medicine, College of MedicineNational Cheng Kung UniversityTainanTaiwan
  7. 7.Chia Nan University of Pharmacy and ScienceTainanTaiwan
  8. 8.Department of Psychiatry, Chia-Yi BranchTaichung Veterans General HospitalChia-YiTaiwan
  9. 9.Division of Pulmonary Medicine, Department of Internal MedicineNational Cheng Kung University HospitalTainanTaiwan
  10. 10.Biostatistics Consulting CenterNational Cheng Kung University HospitalTainanTaiwan

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