An Updated Review on the Relationship of Depressive Symptoms in Obstructive Sleep Apnea and Continuous Positive Airway Pressure

Abstract

Obstructive sleep apnea (OSA) is a common sleep disorder occurring across all age groups, gender, and is multifactorial. The episodic decrease in airflow during sleep results in hypoxia and hypercapnia over time, resulting in morning headache, systemic and pulmonary hypertension, and polycythemia. Fragmentation of sleep at night-time cause daytime somnolence, fatigue, memory problems, and mood symptoms such as depression and anxiety. These secondary mood symptoms could be easily missed by healthcare providers as the primary disorder resulting in unnecessary anti-depressants' prescription. This study investigates the effect of continuous airway pressure (CPAP) on depressive symptoms of OSA. We used PubMed, PubMed Central (PMC), and MEDLINE for data collection. We used OSA, depression, anxiety, mood symptoms, psychological symptoms, and CPAP as the keywords, both alone and in combination. The search ended on November 5, 2020, and it was limited to the year 2010 until the day of the search. However, a few of the papers published earlier than 2010 were also included to have better insight into some aspects of the topic. We included articles measuring the impact of CPAP on mood symptoms using any one of the validated scales, such as the Beck Depression Inventory (BDI), the State-Trait Anxiety Inventory (STAI), Hospital Anxiety and Depression Scale (HADS), or Hamilton Depression Scale (HAM-D). Our initial searches yielded 131 articles. Twenty-one of the 131 papers satisfied the review's criteria. Four studies out of 21 revealed no improvement in OSA-related mood symptoms with CPAP therapy, whereas the others reported beneficial effects on mood, daytime sleepiness, cognition, and patient quality of life.

CPAP Therapy on Depressive and Anxiety Symptoms in Patients with Moderate to Severe Obstructive Sleep Apnea Syndrome

“…A 2019 meta-analysis that involved 73 articles estimated that the prevalence of depressive symptoms and anxiety in a study population with OSA are up to 35% and 32%, respectively [ 1 ]. Symptoms of OSA include snoring, apnea reported by the entourage, choking episodes, sleep fragmentation, insomnia, nocturia, morning headaches, excessive daytime sleepiness, irritability, altered concentration, decrease in memory, and loss of libido [ 3 ].…”

A New Berlin Questionnaire Simplified by Machine Learning Techniques in a Population of Italian Healthcare Workers to Highlight the Suspicion of Obstructive Sleep Apnea

“…Recent systematic reviews and meta-analyses reported that OSA is linked to depression ( 42 ) and anxiety ( 43 ). Other longitudinal studies suggested that patients with OSA are about twice as likely to be depressed than those without OSA ( 44 , 45 ).…”

“Leaky Gut” as a Keystone of the Connection between Depression and Obstructive Sleep Apnea Syndrome? A Rationale and Study Design

“…Current treatments for both depression and OSAS (including its complications) remain suboptimal for many patients. Most of the studies revealed an improvement in OSArelated depressive and anxiety symptoms with continuous positive airway pressure (CPAP) therapy, however, the improvement is far from sufficient [65,66]. Additionally, lower CPAP adherence was shown to be an obstacle [67].…”