Effect of three weeks of continuous positive airway pressure treatment on mood in patients with obstructive sleep apnoea: A randomized placebo-controlled study

Abstract

Background Patients with obstructive sleep apnoea (OSA) commonly have mood symptoms such as depression and anxiety. However, the results of randomized controlled trials on the therapeutic effect of CPAP on mood symptoms have been inconsistent. The present study examined whether 3 weeks of CPAP treatment had specific therapeutic effects on mood symptoms in patients with OSA compared with placebo. Methods A double-blind, parallel, randomized controlled trial using therapeutic and placebo CPAP was performed in 71 patients newly diagnosed with OSA [apnoea-hypopnoea index (AHI) ≥10]. Mood was assessed by the Center for Epidemiologic Studies-Depression (CES-D) Scale, the Profile of Mood States (POMS) and the Brief Symptom Inventory (BSI) before and after 3 weeks of treatment. AHI was used to assess the severity of apnoea. The two groups were compared using a simple comparison of the changes within each arm and repeated measures analysis of variance. Results Fifty-six subjects completed the study: 26 in the CPAP group and 30 in the placebo group. The two groups were well matched at baseline, with no significant differences in demographic, mood and apnoea variables. Both groups had severe apnoea, and mild depression and anxiety at baseline. After 3 weeks of treatment, AHI decreased significantly in the CPAP group. The mean change in AHI was −30.7 [standard deviation (SD) 23.1] in the CPAP group and −5.8 (SD 18.3) in the placebo group (difference between groups P<0.001). However, after 3 weeks of treatment, there were no significant time by treatment effects in relation to mood, as assessed by the CES-D, POMS Depression, POMS Tension, BSI Depression or BSI Anxiety (all P>0.05). Conclusion In conclusion, 3 weeks of CPAP treatment did not show a specific therapeutic effect on mood symptoms in patients with OSA.

The Relationship between Depressive Symptoms and Obstructive Sleep Apnea in Pediatric Populations: A Meta-Analysis

“…76 However, in a double-blind, placebo control study, CPAP treatment dramatically decreased AHI but had no effect on depressed mood. 77 A limitation of these studies included small sample sizes and assessment of depression shortly after treatment duration possibly affecting the outcome.…”

Sleep-Disordered Breathing and Psychiatric Disorders

“…Multivariate analysis showed that chronic depressive symptoms were independently associated with the persistence of excessive daytime sleepiness, comorbid cardiovascular disease and female sex. This study overcame the methodological limitations of previous null studies [25,27,29] with a larger sample size, long-term CPAP use and inclusion of patients with baseline depression. However, the study was still observational with no placebo/sham CPAP arm.…”

“…In another study in |OSA comparing the effect of placebo CPAP, treatment CPAP and nocturnal supplemental oxygen, only supplemental oxygen showed significant improvement in psychological symptoms while a trend was observed towards improvement in depression score with CPAP treatment [26]. Another randomised trial from the same group compared the effects of therapeutic and placebo CPAP for 3 weeks on mood of patients with OSA [27]. Depression was assessed by POMS, Center for Epidemiological Studies Depression (CES-D) and BSI.…”

Sleep-Disordered Breathing and Psychopathology: A Complex Web of Questions and Answers

“…The literature linking SDB with some forms of psychopathology (e.g., ADHD) remains mixed [38,39] and the alleviation of SDB has not always produced improvements in mood symptoms [40]. Furthermore, much of the data linking SDB with different forms of psychopathology, and the effect of CPAP on neuropsychiatric improvement, come from small, shortterm studies [41].…”