Is severe obstructive sleep apnea associated with less depressive symptoms?
Introduction
Obstructive sleep apnea (OSA) is a common sleep disorder characterized by recurrent cessation or reduction in airflow caused by upper airway collapse during sleep. These episodes result in episodic hypoxemia, frequent arousals, and lack of refreshing sleep [1]. In a recent cohort study, the prevalence of OSA, defined by an apnea-hypopnea index (AHI) of ≥5, was 34% in men aged 30–70 years and 17% in women aged 30–70 years, respectively [2]. A recent population-based study showed that the prevalence of moderate to severe OSA (AHI ≥ 15) was 49.7% in men and 23.4% in women [3]. OSA is considered to be an independent risk factor for the development of cardiovascular diseases and depression [[4], [5], [6], [7]].
Psychological disorders such as depression and anxiety are reported to be prevalent in patients with OSA. Previous reports of depression (2.9–78%) and anxiety (2.9–70%) found marked variation between patients, which was likely to be a result of methodological issues [7]. However, a recent systematic review concluded that depression is prevalent among patients with OSA, both in the community and in sleep disorder clinics [8], indicating that depression may be an under-recognized comorbid condition.
Although the high prevalence of depression in patients with OSA [7,8] and improvements in mood following continuous positive airway pressure treatment [9] suggest a direct causative link between OSA and depression, this association has not consistently been reported in the literature. In a cross-sectional study of patients with OSA [10], the prevalence of depressive symptoms was associated positively with severity of OSA. A population-based longitudinal study [11] also showed that worsening of OSA symptoms was strongly related to elevated odds for developing depression. However, other studies examining this association found little or no evidence of a positive relationship [[12], [13], [14], [15], [16]]. In a study that focused on patients with mild OSA, the prevalence of depression and anxiety was reported to be unexpectedly high (41% and 67%, respectively) [16]. Subgroups of patients, such as those experiencing rapid eye movement–related and positional OSA, have demonstrated high levels of depression despite having a substantially milder degree of OSA [[17], [18], [19]]. Furthermore, a recent Norwegian study of 3770 patients with OSA [20] reported that increased severity of OSA was associated with less anxiety and depression. Therefore, further study is warranted to elucidate the connection between severity of OSA and symptoms of depression and anxiety. The aim of the present study was to investigate this relationship in patients with newly diagnosed OSA.
Section snippets
Participants
This cross-sectional study was conducted using our database which consisted of a consecutive series of patients referred to the sleep laboratory of a single university hospital with suspicion of OSA between 2009 and 2012. The database used in this study (including 795 eligible cases) was expanded from the database (including 655 eligible cases) used in our previous study of anxiety and its relationship to quality of life, independent of depression, in patients with OSA [21]. The purpose of the
Participant characteristics
Of 934 consecutive patients who met the inclusion criteria, 126 were excluded because they had comorbid medical, psychiatric, or neurological disorders. An additional 13 patients who had previously been diagnosed with or treated for OSA were also excluded. A final series of 795 patients with OSA (691 males) and a mean age of 49.0 years (SD = 11.9 years) participated in the study (Table 1). The median AHI score was 25.0/h (interquartile range 12.5–42.0/h; Table 1). The mean BDI and STAI-S scores
Discussion
In this study, depression- and anxiety-related symptoms were present in 46.2% and 49.2% of patients with OSA, respectively. Our findings were similar to those of a previous study [26], which used the Beck Anxiety Inventory and BDI to show that the proportions of OSA patients with depression and anxiety were 46.1% and 53.9%, respectively, in people who were observed in a sleep laboratory. A large sample of Chinese patients was randomly selected from a hospital database, and their survey results
Conflict of interest
None.
Acknowledgement
This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.
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These authors have contributed equally to the preparation of the manuscript.