Depressive symptoms in patients with obstructive sleep apnea: biological mechanistic pathways

Abstract

This study examined the association between depressive symptoms, as well as depressive symptom dimensions, and three candidate biological pathways linking them to Obstructive sleep apnea (OSA): (1) inflammation; (2) circulating leptin; and (3) intermittent hypoxemia. Participants included 181 obese adults with moderate-to-severe OSA enrolled in the Cardiovascular Consequences of Sleep Apnea (COSA) trial. Depressive symptoms were measured using the Beck Depression Inventory-II (BDI-II). We assessed inflammation using C-reactive protein levels (CRP), circulating leptin by radioimmunoassay using a double antibody/PEG assay, and intermittent hypoxemia by the percentage of sleep time each patient had below 90% oxyhemoglobin saturation. We found no significant associations between BDI-II total or cognitive scores and CRP, leptin, or percentage of sleep time below 90% oxyhemoglobin saturation after controlling for relevant confounding factors. Somatic symptoms, however, were positively associated with percentage of sleep time below 90% saturation (β = 0.202, P = 0.032), but not with CRP or circulating leptin in adjusted models. Another significant predictor of depressive symptoms included sleep efficiency (β = -0.230, P = 0.003; β = -0.173, P = 0.030 (β = -0.255, P = 0.001). In patients with moderate-to-severe OSA, intermittent hypoxia may play a role in somatic rather than cognitive or total depressive symptoms.

Increased risk of major depressive disorder in sleep apnea patients in Taiwan

“…Although some previous studies have shown the association between SA and depression, the definite mechanisms have not been fully understood 31 . Sleep fragmentation and hypoxemia might contribute to the incident MDD in SA patients.…”

Anatomical Brain Changes and Cognitive Abilities in Patients with Obstructive Sleep Apnea Syndrome and Nonalcoholic Fatty Liver Disease

“…Our patients with OSA had lower concentrations of adiponectin, but this difference was not statistically verified. It has already been published that adiponectin is lower in the examinees with OSA [ 41 , 42 ], and OSA cohabitates with depression symptoms [ 43 ]. The patients with NAFLD are prone to depression [ 36 ]; furthermore, the depression appearance is related to the white matter loss which corresponds to the liver fibrosis grade [ 44 ].…”

Obstructive Sleep Apnea Risk Is Associated with Cognitive Impairment after Controlling for Mild Traumatic Brain Injury History: A Chronic Effects of Neurotrauma Consortium Study

“…A growing literature demonstrates that OSA can cause or exacerbate depressive symptoms, primarily through brain changes related to vascular burden and intermittent hypoxia. 76,77 To avoid circular analyses, depression was excluded from the final model. Similarly, examination of current alcohol consumption, chronic pain, and medications that may also contribute to overall functioning after injury were not included in the model.…”