0557 The Impact of Gender on the Obstructive Sleep Apnea—Depression Relationship

Abstract Introduction Obstructive sleep apnea (OSA) and depression commonly co-exist and have complex relationships. Depressive symptoms may be a particularly common manifestation of OSA among women, with women going undiagnosed with OSA for many years. Conversely, effective OSA treatment may improve depression control. We sought to evaluate the relationship between OSA and depression including the impact of treatment, and how this varies by gender. Methods We linked administrative claims data with objective positive airway pressure (PAP) therapy device usage data to identify a cohort of adult patients diagnosed with OSA, newly initiated on a PAP device, with medical and pharmaceutical claims data available from 1 year prior to 2 years post PAP initiation date (index). Depression was defined by at least 2 healthcare encounters with a depression diagnosis code in the year prior to index, with no depression pre-index defined by no depression diagnosis codes. PAP adherence was categorized as consistently adherent, intermediately adherent, or non-adherent based on objective usage over 2 years. Results A total of 345,707 patients with OSA initiating PAP were included in this analysis, of whom 57,397 (16.6%) had depression, including 25.5% of women and 10.6% of men (p< 0.001). In both women and men, individuals with depression had a greater burden of most comorbidities, including severe obesity, hypertension, type 2 diabetes, coronary artery disease, cerebrovascular disease, and heart failure. Over 2 years, PAP adherence was lower among patients with depression. Women with depression had the lowest proportion of adherent patients (23.3% vs 28.8% men with depression, 31.3% women without depression, 37.8% men without depression, p< 0.001). Hours per day and days per week of PAP use followed this same pattern. Lower PAP adherence was associated with lower rates of antidepressant medication use at 1- and 2-years post-PAP initiation in both women and men. Conclusion We found in a real-world cohort that depression commonly co-exists with OSA, particularly in women. PAP adherence is lower in those with depression, especially among women. This study highlights the need to further understand the impact of depression in women with OSA. Support (if any) ResMed