Depression, physical activity, energy consumption, and quality of life in OSA patients before and after CPAP treatment

Diamanti, C.; Manali, Effrosyni D.; Ginieri-Coccossis, Maria; Vougas, Konstantinos; Cholidou, Kyriaki; Markozannes, Evangelos; Bakakos, Petros; Liappas, Ioannis; Alchanatis, Manos

doi:10.1007/s11325-013-0815-6

Cited by 74 publications

(57 citation statements)

References 35 publications

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“…Defining the role of OSA in the genesis of such symptoms could be achieved by elimination of the condition followed by reassessment. 8 Continuous positive airway pressure (CPAP), the first-line therapy for moderate to severe OSA, provides an opportunity to do so, as it is highly efficacious and compliance with it can be accurately monitored. 9 The present study has been designed to address these issues.…”

Section: S C I E N T I F I C I N V E S T I G At I O N Smentioning

confidence: 99%

Depressive Symptoms before and after Treatment of Obstructive Sleep Apnea in Men and Women

Edwards

Mukherjee

Simpson

et al. 2015

Journal of Clinical Sleep Medicine

109

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Study Objectives: To determine prevalence of depressive symptoms in obstructive sleep apnea (OSA) and the impact of OSA treatment on depression scores. Methods: Consecutive new patients referred for investigation of suspected OSA were approached. Consenting patients completed a patient health questionnaire (PHQ-9) for depressive symptoms when attending for laboratory polysomnography. Those with moderate/severe (apneahypopnea index [AHI] ≥ 15 events/h) and/or symptomatic mild OSA (AHI 5-14.99 events/h) were offered continuous positive airway pressure (CPAP) therapy. PHQ-9 was repeated after 3 months of CPAP with compliance recorded. Of a maximum PHQ-9 score of 27, a cut point ≥ 10 (PHQ-9 ≥ 10) was used to indicate presence of clinically signifi cant depressive symptoms. Results: A total of 426 participants (243 males) were recruited. Mean ± standard deviation body mass index (BMI) was 32.1 ± 7.1 kg/m 2 and AHI 33.6 ± 28.9 events/h. PHQ-9 was 10.5 ± 6.1 and independently related to AHI (p < 0.001) and BMI (p < 0.001). In those without OSA, PHQ-9 ≥ 10 was more common in women, but no gender difference was evident with OSA. Of 293 patients offered CPAP, 228 were compliant (mean nightly use > 5 h) over 3 months of therapy. In them, with therapy, AHI decreased from 46.7 ± 27.4 to 6.5 ± 1.6 events/h, PHQ-9 from 11.3 ± 6.1 to 3.7 ± 2.9 and PHQ-9 ≥ 10 from 74.6% to 3.9% (p < 0.001 in each case). Magnitude of change in PHQ-9 was similar in men and women. Antidepressant use was constant throughout. Conclusions: Depressive symptoms are common in OSA and related to its severity. They improve markedly with CPAP, implying a relationship to untreated OSA. Keywords: patient health questionnaire, depression, depressive symptoms, obstructive sleep apnea, continuous positive airway pressure. Citation: Edwards C, Mukherjee S, Simpson L, Palmer LJ, Almeida OP, Hillman DR. Depressive symptoms before and after treatment of obstructive sleep apnea in men and women. J Clin Sleep Med 2015;11(9):1029-1038.pii: jc-00354-14 http://dx.doi.org/10.5664/jcsm.5020 P ersistent sleep loss causes symptoms that are similar to those of depression, in part because frontal lobe centers responsible for emotional modulation are sensitive to disturbed sleep.1 Consistent with this observation, obstructive sleep apnea (OSA), a condition characterized by fragmented sleep, is commonly associated with depressive symptoms.2 Conversely, depression is often associated with disturbed sleep. Further, depression and OSA are prevalent in the community and, hence, could be expected to coexist in a signifi cant proportion of patients. The multidirectional relationships between depression, disturbed sleep, and OSA are a source of potential diagnostic confusion, which may explain why OSA, a generally under-recognized condition, is particularly under-diagnosed among people with depression.3 Failure to recognize and treat OSA in depressed patients may lead to inappropriate prescription of antidepressant therapy and/or persistence of depressive symptoms despite such therapy....

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Section: S C I E N T I F I C I N V E S T I G At I O N Smentioning

confidence: 99%

Depressive Symptoms before and after Treatment of Obstructive Sleep Apnea in Men and Women

Edwards

Mukherjee

Simpson

et al. 2015

Journal of Clinical Sleep Medicine

109

View full text Add to dashboard Cite

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“…However, no significant improvement in any of the physical activity parameters was found after a mean follow-up of 9 months. 16 Despite the fact that CPAP treatment improved daytime symptoms, there was no apparent explanation for this lack of improvement in physical activity level. Stenlof et al 21 have demonstrated improvement in nocturnal energy expenditure among patients with sleep apnea.…”

Section: Discussionmentioning

confidence: 99%

“…One MET is roughly equivalent to the energy cost of sitting quietly or 0.0175 calories per minute per kilogram of body weight (Kcal/min/kg). 16 This instrument has been validated using double-labeled water and has been shown to be effective in predicting total energy expenditure and physical activity energy expenditure in epidemiologic studies.…”

Section: Assessment Of Physical Activitymentioning

confidence: 99%

“…16,17 Such information is vital, given that both obesity and OSA are independent risk factors for poor health and increased cardiovascular morbidity and mortality. Moreover, lifestyle modifi cations involving diet and physical activity are Study Objectives: Patients with severe OSA consume greater amounts of cholesterol, protein, and fat as well as have greater caloric expenditure.…”

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confidence: 99%

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Impact of CPAP on Activity Patterns and Diet in Patients with Obstructive Sleep Apnea (OSA)

Batool-Anwar

Goodwin

Drescher

et al. 2014

Journal of Clinical Sleep Medicine

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However, there are few studies that have demonstrated the effect of OSA treatment on energy consumption and physical activity. 16,17 Such information is vital, given that both obesity and OSA are independent risk factors for poor health and increased cardiovascular morbidity and mortality. Moreover, lifestyle modifi cations involving diet and physical activity are Study Objectives: Patients with severe OSA consume greater amounts of cholesterol, protein, and fat as well as have greater caloric expenditure. However, it is not known whether their activity levels or diet change after treatment with CPAP. To investigate this issue, serial assessments of activity and dietary intake were performed in the Apnea Positive Pressure Long-term Effi cacy Study (APPLES); a 6-month randomized controlled study of CPAP vs. sham CPAP on neurocognitive outcomes. Methods: Subjects were recruited into APPLES at 5 sites through clinic encounters or public advertisement. After undergoing a diagnostic polysomnogram, subjects were randomized to CPAP or sham if their AHI was ≥ 10. Adherence was assessed using data cards from the devices. At the Tucson and Walla Walla sites, subjects were asked to complete validated activity and food frequency questionnaires at baseline and their 4-month visit. Results: Activity and diet data were available at baseline and after 4 months treatment with CPAP or sham in up to 231 subjects (117 CPAP, 114 Sham). Mean age, AHI, BMI, and Epworth Sleepiness Score (ESS) for this cohort were 55 ± 13 [SD] years, 44 ± 27 /h, 33 ± 7.8 kg/m 2 , and 10 ± 4, respectively. The participants lacking activity and diet data were younger, had lower AHI and arousal index, and had better sleep effi ciency (p < 0.05). The BMI was higher among women in both CPAP and Sham groups. However, compared to women, men had higher AHI only in the CPAP group (50 vs. 34). Similarly, the arousal index was higher among men in CPAP group. Level of adherence defi ned as hours of device usage per night at 4 months was signifi cantly higher among men in CPAP group (4.0 ± 2.9 vs. 2.6 ± 2.6). No changes in consumption of total calories, protein, carbohydrate or fat were noted after 4 months. Except for a modest increase in recreational activity in women (268 ± 85 vs. 170 ± 47 calories, p < 0.05), there also were no changes in activity patterns. S C I E N T I F I C I N V E S T I G A T I O N SO besity is considered a strong risk factor for the development and progression of obstructive sleep apnea (OSA). 1Continuous positive airway pressure (CPAP) is considered the gold standard for OSA treatment and has been shown to improve daytime sleepiness, quality of life, and depressive symptoms, as well as reduce risk for cardiovascular disease and mortality.2-7 Despite these benefi ts, CPAP treatment is not considered curative and its success depends on compliance, which remains a major challenge.8 Thus, overweight patients are encouraged to lose weight with goal of reducing or eliminating the need for CPAP if suffi cient weight loss is achieved. Moreover, t...

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“…156 Another study found similar results in that 6 months of CPAP improved physical health, levels of independence and psychological health using the World Health Organization QOL questionnaire. 157 However, a recent study found that the improvement in QOL following starting CPAP was similar in those who were compliant with treatment versus patients who were not treatment compliant.…”

Section: Obstructive Sleep Apnoea and Quality Of Lifementioning

confidence: 98%

Obstructive Sleep Apnoea and Vascular Disease in Patients with Type 2 Diabetes

Tahrani¹

2015

US Endocrinology

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Obstructive sleep apnoea (OSA) is common and is associated with many vascular risk factors, such as hypertension, insulin resistance, albuminuria, dyslipidaemia, increased inflammation and endothelial dysfunction. Epidemiological studies have shown that OSA is associated with increased cardiovascular disease (CVD) and that continuous positive airway pressure (CPAP) might reduce CVD events in patients with OSA. In addition, OSA has also been shown to be associated with albuminuria, chronic kidney disease, a wide range of ocular diseases and peripheral neuropathy. Considering that CVD and microvascular complications are major contributors to the morbidity, mortality and the economic burden of diabetes and that OSA is common in patients with type 2 diabetes (T2D), it is important to understand the role of OSA in the development and/or progression of vascular disease in patients with T2D and to explore the impact of CPAP on diabetes-related vascular outcomes. The purpose of this article is to review the evidence for the relationship and impact of OSA on vascular disease and vascular risk factors particularly in patients with T2D. KeywordsType 2 diabetes, obstructive sleep apnoea, vascular disease, vascular risk Diabetes-related macro-and microvascular complications contribute significantly to the increased morbidity, mortality, worsened quality of life and social and financial burden observed in patients with diabetes. [1][2][3][4][5] Hence, reducing the development and/or the progression of these complications is one of the main aims of treatment in patients with diabetes.Over the last 2 decades, strategies resulting in the improvements of glycaemic control, blood pressure (BP) and lipids and the use of renin angiotensin aldosterone inhibitors, resulted in reductions in cardiovascular disease (CVD) in patients with diabetes, but there was little impact on diabetic microvascular complications. 6 Nonetheless, both CVD and microvascular complications remain common and a better understanding of the pathogenesis of these complications is needed in order to identify new treatment strategies.Obstructive sleep apnoea (OSA) is common in patients with type 2 diabetes (T2D) (up to 86 % prevalence), which is not surprising considering that increasing age and obesity are common risk factors to both conditions. 7,8 OSA is characterised by upper airway instability during sleep that results in recurrent upper airway obstruction resulting in either complete or partial cessation of airflow (i.e. apnoea and hypopnoea, respectively). 9The recurrent obstructions of the upper airway usually result in recurrent oxygen desaturations/re-saturations, cyclical changes in intrathoracic pressure (as the patient attempts to breath against a blocked airway) and recurrent micro arousals that cause sleep fragmentation and reduction in slow wave and rapid eye movement (REM) sleep and result in termination of the apnoea/hypopnoea episodes. 9Several large epidemiological studies and randomised controlled trials (RCTs) have shown that OSA was ...

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Depression, physical activity, energy consumption, and quality of life in OSA patients before and after CPAP treatment

Abstract: CPAP therapy improves QoL and lessens depressive symptoms in our group of well-treated OSA patients. However, physical activity and energy expenditure did not present statistically significant improvement in the same group of OSA patients.

Cited by 74 publications

References 35 publications

Depressive Symptoms before and after Treatment of Obstructive Sleep Apnea in Men and Women

Depressive Symptoms before and after Treatment of Obstructive Sleep Apnea in Men and Women

Impact of CPAP on Activity Patterns and Diet in Patients with Obstructive Sleep Apnea (OSA)

Obstructive Sleep Apnoea and Vascular Disease in Patients with Type 2 Diabetes

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