Does surgery for obstructive sleep apnea improve depression and sleepiness?

Abstract

Objectives/Hypothesis: To determine if surgical intervention for OSA (obstructive sleep apnea), particularly multilevel surgery, decreases depression and sleepiness.Study Design: Prospective cohort study. Methods: Chart and prospective outcome database review of patients who underwent surgery from August 2008 through November 2012. Patients were evaluated before and after surgery using the Epworth Sleepiness Scale (ESS), the Beck Depression Index (BDI), and overnight polysomnography.Results: Forty-four patients (12 females; 32 males) met inclusion criteria. Mean age of participants was 44.0 years (SD, 10.2); mean body mass index was 31.9 (SD, 9.3). The mean preoperative obstructive respiratory disturbance index (RDI) was 35.8 events/hour (SD, 21.9; range, 6.6-94.2), which decreased to 17.1 (SD, 19.5; range, 0.8-78.1; P < 0.0001). Mean ESS improved from 10.8 (SD, 4.7) to 6.3 (SD, 3.7; P 5 0.0001); whereas BDI scores improved from 8.4 (SD, 8.2) to 4.9 (SD, 6.0; P 5 0.0051). There were 22 (50.0%) patients with excessive daytime sleepiness and 12 (27.3%) patients with depression before surgery. Surgery was associated with resolution of sleepiness in 17 patients (77.3%) and depression in 9 patients (75.0%). In multivariable regression analysis, only change in ESS (P 5 0.003) and baseline BDI (P < 0.001) were associated with improvement in depression. RDI was not significant (P 5 0.15).Conclusions: Surgical treatment of OSA, especially multilevel surgery, resulted in significantly reduced depression, with resolution in 75% of patients. Similarly, surgery resulted in significantly reduced sleepiness, with resolution in 77% of patients. Reduction in sleepiness scores, but not OSA severity, was predictive of improvement in depression scores. Further evaluation with a larger sample size and a control group is warranted.

Associations of Undiagnosed Obstructive Sleep Apnea and Excessive Daytime Sleepiness With Depression: An Australian Population Study

“…Sleep fragmentation and intermittent nocturnal hypoxia have been suggested as mechanisms through which OSA may contribute to depression in patients with OSA. 26 Oxygen saturation, intermittent hypoxia, and the arousal index were not associated with depression in the current study. It is possible that more severe intermittent hypoxia episodes, assessed by desaturations at 4%, may be more strongly associated with depression.…”

Depression in Chronic Rhinosinusitis: A Controlled Cohort Study

“…Asthma, diabetes, and obstructive sleep apnea have all been associated with depression. [24][25][26][27] Given these findings, we investigated the role of these comorbidities in the development of depression in CRS. We found that, even when controlling for these variables, CRS was still associated with higher BDI scores, which indicated independent effects of CRS on depressive symptoms.…”

Uvulopalatopharyngoplasty reduces the incidence of depression caused by obstructive sleep apnea

“…Large‐scale studies are essential to determine the deleterious effect of OSA on the incidence of depression and preventive effect of UPPP . Recently, Ishman et al reported that the Beck depression index decreased after surgery in patients with OSA . However, the study was based on only 44 patients, and its mean follow‐up period was very short: 115 days after surgery.…”

“…6,7 In addition, several studies have shown that continuous positive airway pressure (CPAP) therapy in patients with OSA improved depression. 8,9 However, these findings are often conflicting, and in most studies the results could not be confirmed due to limited population samples. 6,7 Moreover, the impact of surgical treatment for OSA on depression has not been fully assessed.…”

“…Recently, a new theory suggests that biological, metabolic, and neurological dysregulation in patients with OSA contributes to the occurrence of depression . In addition, several studies have shown that continuous positive airway pressure (CPAP) therapy in patients with OSA improved depression . However, these findings are often conflicting, and in most studies the results could not be confirmed due to limited population samples .…”