The effect of positive airway pressure therapy on neurocognitive functions, depression and anxiety in obesity hypoventilation syndrome

Abstract

Background: The aim of this study is to evaluate the presence of neurocognitive dysfunctions, depression and anxiety and the effect of positive airway pressure (PAP) therapy on these alterations in Obesity Hypoventilation Syndrome (OHS) patients. Methods: Ten healthy normal and obese controls, 10 OHS and 10 OSAS patients were included in the study. Short form-36, Beck Depression Scale and State-Trade Anxiety Inventory (STAI 1-2) were performed. Wisconsin Card Sorting Test (WCST), Montreal Cognitive Assessment Scale (MOCA), Enhanced Cued Recall (ECR) and Mini Mental Test (MMT) were used for neurocognitive evaluation. All tests were repeated after one night PAP therapy in OHS and OSAS groups. Results: OHS patients had the lowest scores of physical (PF) and social functioning (SF) in SF-36. The total number of persistent errors and incorrect answers were the highest in OHS group in WCST. The scores of MOCA, ECR and MMT were lower; depression and anxiety scores were higher in OHS group than in controls (p = 0,00). There was a significant increase in the completed categories in OHS after PAP therapy (p = 0,03). There were also significant increases in MOCA, ECR and MMT scores and significant decreases in depression and anxiety scores with respect to PAP therapy. Conclusions: Cognitive dysfunction, depression and anxiety are important under-recognized comorbidities in OHS. It is suggested that short term PAP therapy had positive effects on neurocognitive functions, depression and anxiety but further multicentre, prospective studies with large number of cases are needed to evaluate the effect of long term PAP therapy on these parameters.

The Association Between Adherence to Positive Airway Pressure Therapy and Long-Term Outcomes in Patients With Obesity Hypoventilation Syndrome: A Prospective Observational Study

“…In line with prior studies, we also found improvements in subjective sleepiness (ESS score), 8,13,[29][30][31]34,36,41,45 depressive symptoms (BDI score), 46 and quality of life (SF-36 score) [29][30][31]36,37,46 at the end of the follow-up period. We have previously reported that in patients with OSA, > 6 h/night of PAP use is associated with a greater improvement in ESS, BDI, and SF-36 scores.…”

Assessing Symptom Burden and Depression in Subjects With Chronic Respiratory Insufficiency

“…3,9,33 In contrast to COPD and interstitial lung disease, there are only a few studies concerning depression in OHS. 16,34 Higher scores on the DEPS questionnaire were associated with greater symptom scores in all ESAS categories in our subjects. Similar results have been reported among patients with advanced cancer.…”

“… 3 , 9 , 14 Depressive symptoms increase perceived symptom burden and impair quality of life. 3 , 4 , 15 , 16 They have also been associated with a risk of hospitalization, emergency care use, and impaired prognosis. 14 , 17 , 18 Therefore, systematic screening of depression in patients with advanced respiratory diseases and chronic respiratory insufficiency is warranted.…”

“…Previous studies have focused on different advanced pulmonary diseases, but not on an unselected population of chronic respiratory insufficiency. 1 , 2 , 9 , 16 Therefore, studies describing the overall symptom burden, prevalence of depression, or the relationship between depression and other symptoms in patients with chronic respiratory insufficiency are needed.…”

Obesity and Mental Health

“…Gastric bypass surgery for morbid obesity not only reduces obesity, but also improves mental health as well (Frezza et al, 2007). Further, decreasing Obesity Hypoventilation Syndrome in those with obesity via positive airway pressure therapy reduces symptoms of anxiety and depression (Argun Baris et al, 2016), again pointing to a reduction in obesity and obesity-related symptoms being related to a reduction in mental distress.…”