Association between sleep-disordered breathing and moderate to severe depression in systemic lupus erythematosus: the TRUMP2-SLE study

Objective: Depression is the most frequent mood disorder that impairs quality of life and medication adherence in patients with systemic lupus erythematosus (SLE). Although sleep-disordered breathing (SDB) is a contributor to depression in the general population, its prevalence in SLE patients and its impact on depression are not clear. We employed a clinical epidemiologic approach to examine them in a multicenter cohort of SLE patients. Methods: This was a cross-sectional study of 414 Japanese adults with SLE at five university hospitals. The main exposure was high-risk SDB, assessed with the Berlin Questionnaire. The main outcome was moderate to severe depression assessed using the Patient Health Questionnaire-9. Poisson regression models were fitted with a robust error variance to estimate adjusted prevalence ratios (aPRs). Results: The mean age was 47.5 years and the mean body mass index (BMI) was 22.1 kg/m2. The prevalence of high-risk SDB was 15.2% (95% confidence interval [95% CI] 11.9%-19.0%). The prevalence of moderate or severe depression was 19.1% (95% CI 15.4%-23.2%). High-risk SDB was associated with a greater likelihood of moderate to severe depression (aPR 2.62, 95% CI 1.62-4.24). All the 1-, 2-, and 3-positive risk categories for SDB were associated with moderate to severe depression, in a dose-dependent manner. Conclusion: Among patients with SLE, SDB is common, and high-risk SDB is strongly associated with moderate to severe depression. The signs and symptoms of SDB should prompt a simultaneous evaluation for concomitant depression.