Predictors of symptoms of anxiety and depression in obstructive sleep apnea

Study Objectives: Depression is a risk factor for medication non-compliance. We aimed to identify if depression is associated with poorer adherence during home-based autotitrating continuous positive airway pressure (autoPAP) titration. Design: Mixed retrospective-observational study. Setting: Academic center. Participants: Two-hundred forty continuous positive airway pressure-naïve obstructive sleep apnea (OSA) patients. Measurements:Patients underwent approximately 1 week of home-based autoPAP titration with adherence data downloaded from the device. Electronic hospital records were reviewed in a consecutive manner for inclusion. Three areas of potential predictors were examined: (i) demographics and clinical factors, (ii) disease severity, and (iii) device-related variables. Depression and anxiety were assessed using the Hospital Anxiety and Depression Scale (HADS). Scores on the subscales were categorized as normal or clinical diagnoses of depression (≥ 8) and anxiety (≥ 11). The primary outcome variable was the mean hours of autoPAP used per night. th percentile pressure and autoPAP use. Conclusion: Depression was independently associated with poorer adherence during home-based autoPAP titration. Depression may be a potential target for clinicians and future research aimed at enhancing adherence to autoPAP therapy.

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

Depression May Reduce Adherence during CPAP Titration Trial

Law

Naughton

et al. 2014

“…[7][8][9] It has also been suggested that, among patients with OSA and depression, daytime sleepiness is more strongly related to depression than OSA severity. [8][9][10] Daytime sleepiness has also been shown to be more related to depression than other OSA symptoms in a general population sample. 11 In addition to daytime sleepiness and fatigue, the high comorbidity of insomnia among patients with OSA reported in our previous studies 12,13 could also partially explain elevated levels of depression among this population, as epidemiological studies have reported that individuals with insomnia have nearly four times higher risk for the development of a new depressive disorder in the 3.5 y following insomnia diagnosis.…”

Section: Introductionmentioning

confidence: 99%

The Prevalence of Depression among Untreated Obstructive Sleep Apnea Patients Using a Standardized Psychiatric Interview

Björnsdóttir

Benediktsdóttir

Pack

et al. 2016

Study Objectives: The aims of this study were: (1) to use a standardized psychiatric interview, conducted by a trained psychologist to assess the prevalence of depression among patients with untreated OSA, and (2) to identify if OSA severity or other comorbid disorders (insomnia, hypertension, and diabetes) are related to depression among patients with untreated OSA. Methods: Participants were newly diagnosed patients with OSA (n = 284) waiting to start positive airway pressure (PAP) treatment. The Mini International Neuropsychiatric Interview (MINI) was used to assess depression. Results: Overall, 15.5% of the sample met the diagnosis for dysthymia. Women had a significantly higher prevalence (29.5% versus 11.7% among men, p < 0.001). The prevalence of major depression was 6% in the overall sample and there was no difference in the prevalence among sexes (5.8% among men versus 6.6 % among women). Obesity, daytime sleepiness, low physical activity, initial and late insomnia, low quality of life, and sleep medication and antidepressant use were all related to depression, whereas OSA severity, as measured by apnea-hypopnea index or oxygen desaturation index, was not. Daytime sleepiness, initial insomnia, and sleep medication use were the strongest predictors of depression in multivariable analyses. Conclusions: Sleep medication use, daytime sleepiness, and symptoms of initial insomnia were independently related to depression but OSA severity was not. Increased awareness of the relationship between depression and OSA and the appropriate use of assessment tools might substantially improve diagnostic accuracy as well as treatment outcome for both disorders.

“…Due to the significant negative consequences of OSAHS [13][14][15] and the problem of low rates of adherence with CPAP therapy, 4 interest has increased in identifying factors associated with adherence in OSAHS patients. Research regarding biomedical predictors of CPAP adherence is mixed.…”

Section: Brief Summarymentioning

confidence: 99%

“…Identification of predictors of CPAP adherence is critically important given the many unwanted negative consequences of untreated OSAHS, such as deficits across multiple cognitive domains, 5,6 hypertension, 7,8 type II diabetes, 7 stroke, 7,9,10 reductions in quality-of-life for both the individual with sleep apnea and his or her partner, 11,12 increased rates of psychological disturbances, [13][14][15] and increased mortality risks and economic burden. 1 These negative consequences are striking…”

Section: Introductionmentioning

confidence: 99%

Adherence to Continuous Positive Airway Pressure in Existing Users: Self-Efficacy Enhances the Association between Continuous Positive Airway Pressure and Adherence

Dzierzewski

Wallace

Wohlgemuth

2016

Study Objectives: Obstructive sleep apnea-hypopnea syndrome (OSAHS) is a common sleep disorder associated with a myriad of sequelae. OSAHS is effectively treated with continuous positive airway pressure (CPAP) therapy. However, fewer than 50% of patients are compliant with their CPAP therapy prescriptions. The current study sought to explore an integrated, biopsychological approach to CPAP adherence among experienced CPAP users. Methods: We performed a retrospective, cross-sectional analysis of a cohort of veterans with a diagnosis of OSAHS (n = 191) who were prescribed CPAP therapy and returned for adherence download at the Miami VA Sleep Clinic. The relationships between biomedical characteristics (e.g., CPAP pressure, selfreported sleepiness, and change in sleep efficiency) and psychological factors (e.g., self-efficacy beliefs and psychological diagnoses) and objectively measured CPAP use were examined to determine whether psychological factors moderated the relationships between biomedical characteristics and CPAP adherence. Results: Hierarchical regression analyses predicting CPAP adherence (adjusting for time since CPAP prescription, age, education, prescribed CPAP pressure, daytime sleepiness, changes in sleep efficiency with CPAP, and psychiatric conditions) revealed the following: (1) CPAP self-efficacy and CPAP pressure were positively related to adherence, and (2) CPAP self-efficacy moderates the relationship between CPAP pressure and CPAP adherence. Conclusions: There was no relationship between CPAP pressure and adherence in individuals with low self-efficacy beliefs. However, for individuals with high self-efficacy beliefs, there was a significant positive relationship between CPAP pressure and adherence. Self-efficacy beliefs appear to be a prime target for focused interventions aimed at improving CPAP adherence among those individuals with higher pressure prescriptions. I NTRO DUCTI O NObstructive sleep apnea-hypopnea syndrome (OSAHS) is a very common clinical condition. Population-based estimates suggest that approximately 20% of adults, or one in five, meet the criteria for at least mild OSAHS, based on an apnea-hypopnea index ≥ 5.1 OSAHS can be effectively treated with continuous positive airway pressure (CPAP) therapy.2,3 However, adherence with treatment recommendations is relatively low. 4 We sought to examine previously described biomedical and psychological factors associated with CPAP adherence, as well as investigate whether psychological factors (i.e., self-efficacy beliefs) might modify the association of biomedical characteristics and CPAP adherence.Identification of predictors of CPAP adherence is critically important given the many unwanted negative consequences of untreated OSAHS, such as deficits across multiple cognitive domains, 5,6 when viewed in context of the extremely high nonadherence rates associated with CPAP therapy. Approximately 50% of patients prescribed CPAP are completely noncompliant with therapy recommendation at 1 y. 4 In addition, 15% to 30% of patients with...