Is severe obstructive sleep apnea associated with less depressive symptoms?

https://doi.org/10.1016/j.jpsychores.2019.04.017Get rights and content

Highlights

  • To investigate the relationship between OSA severity and depressive and anxiety symptoms

  • Depression and anxiety were more prevalent in mild OSA than in severe OSA.

  • Excessive daytime sleepiness tended to affect the severity of depressive symptoms.

  • These findings were especially evident for depressive symptoms.

Abstract

Purpose

To investigate the relationship between obstructive sleep apnea (OSA) and symptoms of depression and anxiety in OSA patients.

Methods

Symptoms were assessed using the Beck Depression Inventory (BDI) and the state part of the State-Trait Anxiety Inventory (STAI-S). BDI scores of ≥10 and STAI-S scores of ≥40 were considered to indicate the presence of depression and anxiety, respectively. Apnea severities measured using polysomnography were categorized into mild, moderate, and severe subgroups bounded by the 33rd and 66th percentiles of each polysomnographic parameter. Data were stratified by age, gender, and level of daytime sleepiness.

Results

The study population comprised 795 adult patients (86.9% men). Symptoms of depression and anxiety were present in 46.2% and 49.2% of patients, respectively. Excessive daytime sleepiness was present in 40.0% of patients and did not differ depending on the level of apnea severity. Results of crude logistic regression analyses indicated that depressive symptoms were more prevalent in patients with mild OSA than those with severe OSA, regardless of the categorizing method. These results remained statistically significant following adjustment for several confounding factors. These relationships were similar but less prominent in measures of anxiety. In the sub-analyses, such negative associations between severity of OSA and depressive symptoms tended to be observed only in patients with daytime sleepiness.

Conclusions

Symptoms of depression and anxiety were found to be more prevalent in patients with mild OSA than those with severe OSA. Excessive daytime sleepiness was shown to affect the severity of 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.

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