Long-term effects of CPAP on daytime functioning in patients with sleep apnoea syndrome

Abstract

Daytime sleepiness, impaired cognitive performance and dysphoric mood are often present in patients with obstructive sleep apnoea syndrome (SAS). This prospective controlled study evaluates the effects of treatment with continuous positive airway pressure (CPAP) during 1 yr on daytime functioning in a large group of patients with SAS.The authors studied 80 patients (mean SEM 49 1 yrs) with SAS with a mean apnoea-hypopnoea index of 60 2 h -1 , and 80 healthy control subjects matched for sex and age (46 1 yrs.). Measurements were obtained at the beginning of the study and 12 1 months later, and included: daytime sleepiness (Epworth scale), depression and anxiety (Beck tests), vigilance (Steer-Clear1) and reaction time (Psychometer Vigilance Test 1921). Drug, coffee and alcohol intake, as well as the sleep schedule, were also recorded.Results showed that, before treatment, patients were more somnolent (p<0.001), anxious (p<0.01) and depressed (p<0.001) than control subjects. Also, they had a longer reaction time (p<0.05) and poorer vigilance (p<0.01). The use of CPAP improved significantly the levels of somnolence (p<0.0001) and vigilance (p<0.01), but failed to modify anxiety and depression. Reaction time changes were minor. Variables with a potential confounding effect did not change during the study.These results provide firm evidence to substantiate the use of continuous positive airway pressure in patients with sleep apnoea syndrome. Eur Respir J 2000; 15: 676±681.

Recognizing and Managing Obstructive Sleep Apnea in Primary Care

“…[48][49][50][51] In addition, a recent case study has reported that suicidal ideation and depression were rapidly resolved in a patient with severe OSA after initiation of CPAP treatment. 52 Conversely, a number of studies have reported that CPAP does not affect depression scores in patients with OSA [53][54][55][56] ; however, a comprehensive meta-analysis has revealed that all of these negative studies investigated patients who had mild depression at baseline or excluded patients with major depressive disorder. 26 This study design may have skewed the study outcomes toward a negative result, as it has been reported previously that patients with OSA and more severe mood disorders receive the greatest benefit from CPAP.…”

Impact of CPAP on Activity Patterns and Diet in Patients with Obstructive Sleep Apnea (OSA)

“…Another large, prospective, controlled study examining the long-term effects of CPAP did not find any significant change in alcohol and coffee intake during the course of the study. 23 However, other dietary habits and caloric intake were not assessed. In a previous cross-sectional analysis of these APPLES In such models, Y is the dependent variable, a is the intercept with the Y axis, b 1 is beta coefficient for X 1 (1 st independent variable), b 2 is the beta coefficient for X 2 (2 nd independent variable), b 3 is the beta coefficient for X 3 (3 rd independent variable), etc.…”

Obstructive Sleep Apnea and Depression: A Review

“…Borak et al 73 found no improvement in emotional status relevant to depression after three and 12 months of CPAP therapy in 20 patients with severe OSA. Similarly Munoz et al 59 found no improvement of BDI scores in 80 subjects with severe OSA after 12 months of CPAP. In these negative studies the CPAP adherence was not monitored.…”

“…Serotonin has been implicated in depression. 59 Serotonin also influences upper airway dilator motor neurons through the hypoglossal nucleus, which is further reduced in sleep states. 58 Abnormalities in central and peripheral neurotransmission of serotonin have been implicated as a potential factor in depression.…”

“…58 Antidepressants have also been shown to increase hippocampus volume via neurogenesis in depressed patients. 59 The role of serotonin in the neurobiology of depression and upper airway control in OSA. Serotonin has been implicated in depression.…”