Sleep Disordered Breathing and Depression among U.S. Adults: National Health and Nutrition Examination Survey, 2005-2008

STUDY OBJECTIVE: To determine if symptoms of sleep disordered breathing (SDB) are associated with depression symptomology in a national sample. DESIGN: National Health and Nutrition Examination Survey. SETTING: U.S., 2005-2008. PARTICIPANTS: 9,714 adults (≥ 18 years). MEASUREMENTS: Respondents were asked about frequency of snoring and snorting, gasping, or stopping breathing while asleep and completed the PHQ-9 (a 9-item depression screener). Odds ratios (OR) and 95% confidence intervals (CI) for SDB symptom-associated probable major depression (defined as a PHQ-9 score ≥ 10) were obtained from sex-specific logistic regression analyses adjusted for body mass index, age, race/ethnicity, and education. RESULTS: Among men, 6.0% reported physician-diagnosed sleep apnea, 37.2% snored ≥ 5 nights/week, 7.1% snorted/stopped breathing ≥ 5 nights/week, and 5.0% had PHQ-9 scores ≥ 10. Among women, 3.1% reported sleep apnea, 22.4% snored ≥ 5 nights/week, 4.3% snorted/stopped breathing ≥ 5 nights/week, and 8.4% had PHQ-9 scores ≥ 10. Sleep apnea was associated with probable major depression (OR = 2.4; 95% CI: 1.5, 3.6 among men; OR = 5.2; 95% CI: 2.7, 9.9 among women). Snoring was not associated with depression symptoms in men or women. Snorting/stopping breathing ≥ 5 nights/week compared to never was strongly associated with probable major depression in men (OR = 3.1; 95% CI: 1.8, 5.2) and women (OR = 3.0; 95% CI: 1.6, 5.4). CONCLUSION: Frequent snorting/stopping breathing was associated with probable major depression by the PHQ-9 in a national sample of adults. Additional research may be needed to determine whether regular screening for these conditions by mental health professionals and sleep specialists should be recommended.