Effect of CPAP on depressive symptoms in OSA

El-Dahdouh, Samy S.; El-Habashy, Mahmoud M.; El-Bahy, Mohamed

doi:10.1016/j.ejcdt.2013.11.009

Cited by 4 publications

(5 citation statements)

References 23 publications

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“…3. The prevalence of mental disorders in OSA is estimated in wide ranges: anxiety disorder from 11% to 70% [39], depressive disorder from 22.7% to 33.9% [54,55,56], bipolar disorder from 3.3% [74] to 24.5% [64], cognitive impairment is 47.9% [31]. 4.…”

Section: Discussionmentioning

confidence: 99%

“…The lifetime prevalence of major depressive disorder ranges within countries from 3% to 16.9% [53]. In OSA patients the prevalence ranges from 22.7% to 33.9% [54,55,56]. Evidence indicates that continuous positive airway pressure in the treatment of OSA can have a positive impact on depressive symptoms [41,54,57], quality of life, sleep-related symptoms, anxiety, and neurocognition [41,57].…”

Section: Osa and Depressive Disordermentioning

confidence: 99%

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The relationships between obstructive sleep apnea and psychiatric disorders: a narrative review

Karakuła

Ryczkowski

Sitarz

et al. 2021

Current Problems of Psychiatry

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Introduction: Obstructive sleep apnea (OSA) is the most common sleep-related breathing disorder. Its prevalence tends to increase worldwide. Untreated sleep apnea is associated with a higher risk of metabolic diseases, cardiovascular diseases, stroke, road accidents, and death, but also it is suggested that it increases the risk of mental disorders. Method: The literature review was based on a search of articles on Medline, Pubmed, and Google Scholar from 2003 to 2021 using the keywords: obstructive sleep apnea; mental disorders; cognitive functions; affective disorders; depression; bipolar disorder; schizophrenia; psychotic disorders. The analysis included original studies, meta-analysis, and review articles. Discussion: The result obtained from researches published so far does not allow for drawing unequivocal conclusions. There is a lot of bias present in study protocols and inclusion/exclusion criteria. Nonetheless, it seems that some disorders have a better proven correlation with OSA. Cognitive impairment, depression, and anxiety disorders are linked to OSA not only in terms of the overlapping of symptoms but also of a causal relationship. Psychotic disorders and bipolar disorders connections with OSA are confirmed, but they are not yet well understood. All correlations are found to be possibly bidirectional. Conclusion: 1. Multiple lines of evidence increasingly point towards a bidirectional connection between OSA and mental disorders, and the cause and effect relationship between these two groups of disorders requires further research. 2. Due to reports of an increased risk of OSA with antipsychotic drugs, caution should be exercised when initiating therapy with this type of drug in patients with known risk factors for it. 3. Screening for OSA in psychiatric patients should be introduced as OSA can increase cognitive impairment, affective, and psychotic symptoms.

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Section: Discussionmentioning

confidence: 99%

Section: Osa and Depressive Disordermentioning

confidence: 99%

The relationships between obstructive sleep apnea and psychiatric disorders: a narrative review

Karakuła

Ryczkowski

Sitarz

et al. 2021

Current Problems of Psychiatry

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“…The use of the SCID allowed us to make the diagnosis of depression based on the presence of cardinal symptoms of depression (anhedonia, dysphoria) that do not overlap with OSA, mitigating against inflated diagnoses. In two uncontrolled studies that used the SCID both before and after two months of CPAP, around a third of the sample were found to meet criteria for unipolar depressive disorders at baseline (29.7%-33%), with half these participants remitting at follow-up (i.e., they no longer met criteria for any depressive disorder; Eldahdouh et al, 2014;El-Sherbini et al, 2011). A third study used a SCID before uvulopalatopharyngoplasty surgery and 6 months post-surgery in 53 OSA patients, observing a reduction in those who met criteria for a current depressive episode from 34% to 10%, and no new cases of depression reported (Dahlof et al, 2000).…”

Section: Discussionmentioning

confidence: 99%

“…Evidence regarding the impact of CPAP treatment on the remission of clinical depression using structured interviews in patients with OSA and comorbid clinical depression is scarce. Two previous uncontrolled studies have used the gold-standard structured clinical interview for depression (SCID) both before and after two months of CPAP treatment, showing that over half of the sample no longer met the criteria for depression at follow-up (Eldahdouh et al, 2014;El-Sherbini et al, 2011). Two other studies have reported improvements on the Hamilton Rating Scale for Depression in patients with OSA after two to three months of CPAP therapy (Bucks et al, 2018;Habukawa et al, 2010), which was associated with improvements in daytime sleepiness (Habukawa et al, 2010).…”

mentioning

confidence: 99%

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

Jackson

Tolson

Schembri

et al. 2020

Depression and Anxiety

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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.

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“…Co-morbid depression is common (21–41%) in OSA patients [ 2 – 4 ]. Recent studies showed that symptoms of depression were alleviated in OSA patients treated with continuous positive airway pressure [ 5 , 6 ]. Besides, depressive-like behavior was observed in experimental animals given the treatment of chronic intermittent hypoxic (CIH) [ 7 , 8 ].…”

Section: Introductionmentioning

confidence: 99%

Monoamine oxidase A upregulated by chronic intermittent hypoxia activates indoleamine 2,3-dioxygenase and neurodegeneration

Lam

Tipoe

et al. 2017

PLoS ONE

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Co-morbid depression is prevalent in patients with obstructive sleep apnea. Here we report that monoamine oxidase A (MAO-A) plays pathogenic roles in the comorbidity. We found that chronic intermittent hypoxia significantly increased the MAO-A expression in the rat hippocampus and markedly decreased the dendritic length and spine density in the pyramidal neurons with less pre- and post-synaptic proteins. The MAO-A upregulation resulted in increased 5-hydroxyindoleacetic acid/serotonin ratio, oxidative stress, leading to NF-κB activation, inflammation and apoptosis. Also, the expression of cytokine-responsive indoleamine 2,3-dioxygenase-1 (IDO-1) was significantly augmented in hypoxia, resulting in increased kynurenine/tryptophan ratio and lowered serotonin level in the hippocampus. Moreover, depressive-like behaviors were observed in the hypoxic rat. Administration of M30, a brain-selective MAO-A inhibitor with iron-chelating properties, prior to hypoxic treatment prevented the aberrant changes in the hippocampus and depressive behavior. In human SH-SY5Y cells expressing MAO-A but not MAO-B, hypoxia significantly increased the MAO-A expression, which was blocked by M30 or clorgyline. Collectively, the MAO-A upregulation induced by chronic intermittent hypoxia plays significant pathogenic role in oxidative stress, inflammation and IDO-1 activation resulting in serotonin depletion and neurodegeneration.

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Effect of CPAP on depressive symptoms in OSA

Cited by 4 publications

References 23 publications

The relationships between obstructive sleep apnea and psychiatric disorders: a narrative review

The relationships between obstructive sleep apnea and psychiatric disorders: a narrative review

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

Monoamine oxidase A upregulated by chronic intermittent hypoxia activates indoleamine 2,3-dioxygenase and neurodegeneration

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