Sleep quality and mental health during the COVID-19 pandemic in patients with severe obstructive sleep apnea

Abstract

Background The first wave of the COVID-19 pandemic has produced remarkable effects on the sleep quality and mental status of the general population and more dramatic effects on patients with chronic illness. Patients with obstructive sleep apnea (OSA), already suffering from disordered sleep, might be more susceptible to the effect of the pandemic on their sleep quality and mental health. We therefore performed a case–control study to compare sleep quality, depression and anxiety symptoms reported by patients with severe OSA and age-matched healthy subjects during the first wave of the COVID-19. In June–July 2020 we enrolled a total of 222 patients with severe OSA, all treated with continuous positive airway pressure, and 164 healthy controls. Self-reported sleep quality was assessed using the Pittsburg Sleep Quality Index (PSQI). Symptoms of depression were assessed using the Patient Health Questionnaire module 9 (PHQ-9), while the specific “Coronavirus Anxiety Scale” (CAS) evaluated the level of anxiety. Results Patients with OSA (61% males, 65 ± 9.6 years old, BMI 30.5 ± 3.6) and healthy controls had similar characteristics except for BMI slightly lower in controls. The perceived quality of sleep, referred to the pre-pandemic period, was significantly worse in patients with OSA than in controls. During the pandemic the rate of reported sleep disturbance increased from 54 to 66% in patients with OSA and from 29 to 40% in controls. A high percentage of patients and controls reported symptoms of depression (61% OSA and 65% controls), whereas lower levels of anxiety, similar in the two groups, were observed. In patients with OSA the PSQI score significantly positively correlated with the PHQ-9 score (r2 = 0.81) and the CAS score (r2 = 0.65). Conclusion The rate of reported sleep disturbance in patients with OSA during the first wave of the COVID-19 pandemic is one of the highest evidenced in literature so far. As for the general population, in these patients there is a strict link between the perceived sleep quality and the psychological distress caused by the pandemic. A further deterioration of sleep quality is a fearsome event in the life of these patients who face life-long sleep problems.

Assessing the causal associations of sleep apnea with mental health and socioeconomic status: a bidirectional two-sample Mendelian randomization

“…According to the prevalence meta-analysis, there may be a higher prevalence of SA in people with major depressive disorder, while there is insu cient data to suggest a higher incidence of SA in people with bipolar disorder and schizophrenia(26), which is consistent with our ndings. Furthermore, our study could not support the contribution of SA to psychiatric disorders, including ADHD, bipolar disorder, major depressive disorder, schizophrenia, and anxiety disorders, while the available observational evidence was contradictory (4,6,27).…”

Assessing the causal associations of sleep apnea with mental health and socioeconomic status: a bidirectional two-sample Mendelian randomization

“…According to the prevalence meta-analysis, there may be a higher prevalence of SA in people with major depressive disorder, while there is insufficient data to suggest a higher incidence of SA in people with bipolar disorder and schizophrenia [ 31 ], which is consistent with our findings. Furthermore, our study could not support the contribution of SA to psychiatric disorders, including ADHD, bipolar disorder, major depressive disorder, schizophrenia, and anxiety disorders, while the available observational evidence was contradictory [ 5 , 7 , 32 ].…”

Quality of Life, Mental Health, and CPAP Compliance in Thai Patients with Obstructive Sleep Apnea during COVID-19 Pandemic

“…The rate of sleep disturbance increased from 54% to 66% in OSA patients and from 29% to 40% in the control group during the COVID-19 pandemic, as reported by Spicuzza et al However, there was no significant difference in the percentage of depression between OSA patients and controls (61% vs. 65%) [ 15 ]. A review by Gill et al found that adherence to CPAP therapy may have improved, and the use of remote consultations and telemonitoring increased during the COVID-19 pandemic [ 16 ].…”