Chu Che-Sheng, Huang Kai-Lin, Bai Ya-Mei, Su Tung-Ping, Tsai Shih-Jen, Chen Tzeng-Ji, Hsu Ju-Wei, Liang Chih-Sung, Chen Mu-Hong
Department of Psychiatry, Kaohsiung Veterans General Hospital, Kaohsiung City, Taiwan; Center for Geriatrics and Gerontology, Kaohsiung Veterans General Hospital, Kaohsiung City, Taiwan; Non-invasive Neuromodulation Consortium for Mental Disorders, Society of Psychophysiology, Taipei, Taiwan; Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.
Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Taiwan; Department of Psychiatry, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.
J Psychiatr Res. 2023 May;161:419-425. doi: 10.1016/j.jpsychires.2023.03.028. Epub 2023 Mar 20.
Previous studies have presented evidence on the association between sleep apnea and suicidal ideation and planning, but the relationship between a clinical diagnosis of sleep apnea and suicide attempts remains unknown. We investigated the risk of suicide after a diagnosis with sleep apnea using data from a nationwide community-based population database, i.e., the Taiwan National Health Insurance Research Database. We recruited 7,095 adults with sleep apnea and 28,380 age-, sex-, and comorbidity-matched controls between 1998 and 2010 and followed them up until the end of 2011. Individuals who exhibited any (once or repeated) suicide attempts were identified during the follow-up period. The E value was calculated for unmeasured bias. Sensitivity analysis was conducted. Patients with sleep apnea were more likely to carry out any suicide attempt (hazard ratio: 4.53; 95% confidence interval: 3.48-5.88) during the follow-up period than the controls after adjusting for demographic data, mental disorders, and physical comorbidities. The hazard ratio remained significant after excluding individuals with mental disorders (4.23; 3.03-5.92). The hazard ratio was 4.82 (3.55-6.56) for male patients and 3.86 (2.33-6.38) for female patients. Consistent findings of increased risk of repeated suicide attempt were found among patients with sleep apnea. No association was found between continuous positive airway pressure treatment and suicide risk. The calculated E values support suicide risk after the diagnosis of sleep apnea. The risk of suicide was 4.53-fold higher in patients diagnosed with sleep apnea than in their counterparts without sleep apnea.
既往研究已提供了睡眠呼吸暂停与自杀意念及计划之间关联的证据，但睡眠呼吸暂停的临床诊断与自杀未遂之间的关系仍不清楚。我们使用来自全国基于社区的人群数据库（即台湾全民健康保险研究数据库）的数据，调查了睡眠呼吸暂停诊断后自杀的风险。我们招募了7095名患有睡眠呼吸暂停的成年人以及28380名年龄、性别和合并症相匹配的对照，时间跨度为1998年至2010年，并对他们进行随访直至2011年底。在随访期间确定了有任何（一次或多次）自杀未遂行为的个体。计算了未测量偏倚的E值。进行了敏感性分析。在调整人口统计学数据、精神障碍和躯体合并症后，患有睡眠呼吸暂停的患者在随访期间比对照组更有可能实施任何自杀未遂行为（风险比：4.53；95%置信区间：3.48 - 5.88）。排除患有精神障碍的个体后，风险比仍然显著（4.23；3.03 - 5.92）。男性患者的风险比为4.82（3.55 - 6.56），女性患者为3.86（2.33 - 6.38）。在患有睡眠呼吸暂停的患者中发现了重复自杀未遂风险增加的一致结果。未发现持续气道正压通气治疗与自杀风险之间存在关联。计算出的E值支持睡眠呼吸暂停诊断后的自杀风险。被诊断患有睡眠呼吸暂停的患者自杀风险比没有睡眠呼吸暂停的对应患者高4.53倍。
