The relationships between improvements in daytime sleepiness, fatigue and depression and psychomotor vigilance task testing with CPAP use in patients with obstructive sleep apnea

Bhat, Sushanth; Gupta, Divya; Akel, Omar; Polos, Peter; DeBari, Vincent A.; Akhtar, Shaista; McIntyre, Anna; Ming, Sue X.; Upadhyay, Hinesh; Chokroverty, Sudhansu

doi:10.1016/j.sleep.2018.06.012

Cited by 26 publications

(21 citation statements)

References 58 publications

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“…to reports in other studies [48][49][50][51][52][53]. In studies that do report an association between OSA severity and sleepiness, OSA severity still explains less than 10% of the total variance in PVT Lapses [4] and even less in subjective sleepiness [49]. This unexpectedly poor relationship is the problem we hope to improve with the present further analysis of the sleep EEG.…”

Section: Comparison With Previous Studiessupporting

confidence: 46%

“…Excessive daytime sleepiness (EDS) is a widely reported and presumed reversible symptom in patients with obstructive sleep apnea (OSA) [1][2][3]. EDS in OSA patients has been associated with depressive symptoms [4], impaired attention, and reduced vigilance [5][6][7] and is known to be a risk factor for motor vehicle and work-related accidents [8]. Although EDS is often measured subjectively with a self-reported questionnaire such as the Epworth Sleepiness Scale (ESS) [9] or objectively with the Multiple Sleep Latency Test (MSLT) [10], the psychomotor vigilance test (PVT) [11] is often used as a measurable surrogate for sleepiness [12].…”

Section: Introductionmentioning

confidence: 99%

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Slow-wave activity surrounding stage N2 K-complexes and daytime function measured by psychomotor vigilance test in obstructive sleep apnea

Parekh¹,

Mullins

Kam

et al. 2018

Sleep

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Study Objective: To better understand the inter-individual differences in neurobehavioral impairment in obstructive sleep apnea (OSA) and its treatment with continuous positive airway pressure (CPAP), we examined how changes in sleep electroencephalography (EEG) slow waves were associated with next-day psychomotor vigilance test (PVT) performance.Methods: Data from 28 OSA subjects (Apnea-Hypopnea Index with 3% desaturation and/or with an associated arousal [AHI3A] > 15/hour; AHI3A = sum of all apneas and hypopneas with 3% O 2 desaturation and/or an EEG arousal, divided by total sleep time [TST]), who underwent three full in-lab nocturnal polysomnographies (NPSGs: chronic OSA, CPAP-treated OSA, and acute OSA), and 19 healthy sleepers were assessed. Four 20-minute PVTs were performed after each NPSG along with subjective and objective assessment of sleepiness. Three EEG metrics were calculated: K-complex (KC) Density (#/minute of N2 sleep), change in slow-wave activity in 1-second envelopes surrounding KCs (ΔSWAK), and relative frontal slow-wave activity during non-rapid eye movement (NREM) (%SWA).Results: CPAP treatment of OSA resulted in a decrease in KC Density (chronic: 3.9 ± 2.2 vs. treated: 2.7 ± 1.1; p < 0.01; mean ± SD) and an increase in ΔSWAK (chronic: 2.6 ± 2.3 vs. treated: 4.1 ± 2.4; p < 0.01) and %SWA (chronic: 20.9 ± 8.8 vs. treated: 26.6 ± 8.6; p < 0.001). Cross-sectionally, lower ΔSWAK values were associated with higher PVT Lapses (chronic: rho = −0.55, p < 0.01; acute: rho = −0.46, p = 0.03). Longitudinally, improvement in PVT Lapses with CPAP was associated with an increase in ΔSWAK (chronic to treated: rho = −0.48, p = 0.02; acute to treated: rho = −0.5, p = 0.03). In contrast, OSA severity or global sleep quality metrics such as arousal index, NREM, REM, or TST were inconsistently associated with PVT Lapses. Conclusion:Changes in EEG slow waves, in particular ΔSWAK, explain inter-individual differences in PVT performance better than conventional NPSG metrics, suggesting that ΔSWAK is a night-time correlate of next-day vigilance in OSA.

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Section: Comparison With Previous Studiessupporting

confidence: 46%

Section: Introductionmentioning

confidence: 99%

Slow-wave activity surrounding stage N2 K-complexes and daytime function measured by psychomotor vigilance test in obstructive sleep apnea

Parekh¹,

Mullins

Kam

et al. 2018

Sleep

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“…To our knowledge, this is the first study on the presence and changes after CPAP therapy of cognitive-affective depression and anxiety symptoms in patients with OSA including not only the measurement of dysthymia but also the distinctive component of depression, i.e., euthymia. Although the prevalence and treatment response of these symptoms in OSA have been widely addressed in previous epidemiological and original research [16][17][18][34][35][36][37][38][39][40], the use of mood disturbances scales including overlapping symptoms, as well as the non-consideration of euthymia as the distinctive feature of depression, have potentially led to inconsistencies and unclear results in this field. Our results therefore have robust clinical and research implications, further supporting the potential overestimation of depression and anxiety prevalence in patients with OSA found throughout the large body of literature in this field [59].…”

Section: Discussionmentioning

confidence: 99%

“…Similarly, there have been inconsistent findings regarding CPAP effects on OSA associated depression and anxiety symptoms [34]. While some clinical research found that a twelve-week CPAP use significantly reduced depression symptoms in patients with moderate to severe OSA [35][36][37], other studies indicated no significant changes in these psychological disturbances after CPAP treatment [38][39][40]. These controversial results may be explained by both (a) cofounder variables in the association between anxiety-depression and OSA, and (b) commonly used anxiety and depression scales.…”

Section: Introductionmentioning

confidence: 99%

Anxiety and Depression in Patients with Obstructive Sleep Apnoea before and after Continuous Positive Airway Pressure: The ADIPOSA Study

Carneiro‐Barrera

Amaro‐Gahete

Sáez-Roca

et al. 2019

JCM

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The prevalence and treatment response of depression and anxiety symptoms in obstructive sleep apnoea (OSA), although widely addressed in research and clinical settings, still remain unclear due to overlapping symptoms. The ADIPOSA study sought to elucidate the presence of non-overlapping symptoms of depression and anxiety in patients with moderate to severe OSA before and after continuous positive airway pressure (CPAP) treatment. Forty-eight adults aged 18-80 (68.75% men) with moderate to severe OSA were enrolled in this twelve-week longitudinal single-arm trial and completed a full-night ambulatory sleep diagnostic test and an assessment of cognitive-affective depression and anxiety symptoms using the Beck-Depression Inventory-Fast Screen (BDI-FS), the State-Trait Depression Inventory (IDER) and the State-Trait Anxiety Inventory (STAI). We found no cognitive-affective depression or anxiety symptoms of clinical relevance at baseline. The amelioration of depression and anxiety symptoms after CPAP use was only statistically significant when considering anxiety-trait (p < 0.01; d = 0.296) and euthymia (p < 0.05; d = 0.402), the distinctive component of depression. Although dysthymia or high negative affect remained unchanged, CPAP may be effective at reducing the lack of positive affect, a well-established health-protective factor. However, not until depression and anxiety disorders related to OSA are accurately measured in clinical and research settings will it be possible to obtain robust conclusions on the occurrence and amelioration of these symptoms after treatment.

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“…In general, individuals with obstructive sleep apnea (OSA) show a high prevalence of depression [9], and depression and tiredness are highly correlated traits [10]. Treatment of OSA with positive airway pressure (PAP) has been documented to result in subjective alleviation of daytime sleepiness, fatigue and depression [11].…”

Section: Introductionmentioning

confidence: 99%

Positive airway pressure therapy for obstructive sleep apnea in patients with Osteogenesis imperfecta: a prospective pilot study

Arponen

Bachour

Bäck

et al. 2021

BMC Musculoskelet Disord

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Background Obstructive sleep apnea (OSA) is prevalent in individuals with Osteogenesis imperfecta (OI). To date, no study has investigated treatment of OSA in adult individuals with OI using positive airway pressure (PAP). This observational pilot study examined the adherence of adults with OI to treatment of OSA with PAP therapy, and the evolution of self-experienced sleepiness and depression symptoms before and after treatment. Methods We included 20 patients, with a mean age of 51 years, who represented varying severity of OI and displayed an apnea and hypopnea index ≥ 5 /sleeping hour as recorded by an overnight polysomnography. PAP therapy was proposed to all patients. Epworth Sleepiness Scale (ESS) questionnaire to evaluate daytime sleepiness, and a validated self-rating depression questionnaire to identify possible depression, were completed prior to PAP therapy and repeated after a minimum of one year. The datasets supporting the conclusions of this article are included within the article. Results From the 20 patients, 15 initiated PAP therapy, and two patients later interrupted it. The mean PAP follow-up period was 1230 days. At baseline, an abnormally high ESS score was reported by 29% of the respondents, and an abnormally high number of symptoms suggesting depression by 29%. Follow-up questionnaires were completed by 60% of the patients, of whom 83% were adherent to PAP treatment. ESS score and depression symptoms did not decrease significantly with PAP therapy. Conclusions Patients with OI accepted well PAP therapy and remained compliant. Sleepiness and depression persisted unaltered despite good PAP adherence. These unexpectedly poor improvements in symptoms by PAP therapy may be due to subjective depression symptoms and the complexity of factors underlying persisting sleepiness in OI. Further research is needed to confirm this novel finding.

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The relationships between improvements in daytime sleepiness, fatigue and depression and psychomotor vigilance task testing with CPAP use in patients with obstructive sleep apnea

Cited by 26 publications

References 58 publications

Slow-wave activity surrounding stage N2 K-complexes and daytime function measured by psychomotor vigilance test in obstructive sleep apnea

Slow-wave activity surrounding stage N2 K-complexes and daytime function measured by psychomotor vigilance test in obstructive sleep apnea

Anxiety and Depression in Patients with Obstructive Sleep Apnoea before and after Continuous Positive Airway Pressure: The ADIPOSA Study

Positive airway pressure therapy for obstructive sleep apnea in patients with Osteogenesis imperfecta: a prospective pilot study

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