Does continuous positive airways pressure treatment improve clinical depression in obstructive sleep apnea? A randomized wait‐list controlled study

Abstract

Background: Obstructive sleep apnea (OSA) is a highly prevalent sleep disorder that is associated with a range of adverse daytime sequelae, including significantly higher rates of clinical depression than is seen in the general community. Improvements in depressive symptoms occur after treatment of the primary sleep disorder, suggesting that comorbid depression might be an intrinsic feature of OSA. However, there are limited data on whether treatment for OSA in patients diagnosed with clinical depression improves mood symptoms meaningfully enough to lead to the remission of the psychiatric diagnosis.Methods: N = 121 untreated OSA patients were randomized to either continuous positive airway pressure (CPAP) treatment or waitlist control, and depressive symptoms, sleepiness and clinical depression (using a structured clinical interview) were assessed at baseline and 4 months. Linear and logistic regression analyses were conducted, controlling for baseline scores, stratification factors and antidepressant use. Results: Depressive symptoms (odds ratio [OR] = −4.19; 95% confidence interval [CI] =−7.25, −1.13; p = .008) and sleepiness (OR = −4.71; 95% CI = −6.26, −3.17; p < .001) were significantly lower at 4 months in the CPAP group compared to waitlist. At 4 months, there was a significant reduction in the proportion of participants in the CPAP group meeting criteria for clinical depression, compared to the waitlist controls (OR = 0.06, 95% CI = 0.01, 0.37; p = .002). Conclusion:Treatment of OSA may be a novel approach for the management and treatment of clinical depression in those with comorbid sleep disordered breathing.Larger trials of individuals with clinical depression and comorbid OSA are needed.

Screening for Obstructive Sleep Apnea in Adults

“…Sixty-three RCTs (74 articles) comparing positive airway pressure with sham positive airway pressure (29 RCTs, 33 articles) or another inactive control (34 RCTs, 41 articles) reported at least 1 eligible health outcome. Most trials identified participants from sleep clinics or referrals, and none focused on persons who were screen detected in primary care settings.…”

Obstructive Sleep Apnea in Emotional Memory: Importance of Rapid Eye Movement Sleep and Window into Mental Health

“…Notably, individuals with REM-related OSA displayed worse depression and total mood disturbance subscale scores on the Profile of Mood Scale than individuals without OSA or even combined non-REM and REM OSA ( 10 ). Several randomized clinical trials of OSA treatment with positive airway pressure have demonstrated improvement in depression and anxiety scores ( 11 ), including the very large Sleep and Vascular Endpoints (SAVE) trial, despite only 3.3 average hours of positive airway pressure adherence in those randomized to positive airway pressure ( 12 ). However, most studies have evaluated treatment-associated mood changes in subjects with OSA, but not specifically in individuals with OSA and comorbid psychiatric disease.…”

Comorbid Major Depressive Disorder and Obstructive Sleep Apnea

“…Clinically interesting points in the treatment of the two conditions include the following: Several studies found that treating OSA patients with comorbid depression with CPAP can improve mood, cognitive and insomnia symptoms. [ 26 – 29 ] Effective treatment of depression may improve acceptance of OSA treatment and increase motivation to treatment, such as adherence to CPAP use. Using sedative or hypnotic agents, especially benzodiazepines, to aid sleep or reduce anxiety, can worsen OSA symptoms due to muscle relaxation and respiratory depression.…”

“…Several studies found that treating OSA patients with comorbid depression with CPAP can improve mood, cognitive and insomnia symptoms. [ 26 – 29 ]…”

“…Clinically interesting points in the treatment of the two conditions include the following: 3 Case Reports in Psychiatry (1) Several studies found that treating OSA patients with comorbid depression with CPAP can improve mood, cognitive and insomnia symptoms. [26][27][28][29] (2) Effective treatment of depression may improve acceptance of OSA treatment and increase motivation to treatment, such as adherence to CPAP use.…”