Depression May Reduce Adherence during CPAP Titration Trial

Law, Mandy; Naughton, Matthew T.; Ho, Sally; Roebuck, Teanau; Dabscheck, Eli

doi:10.5664/jcsm.3444

Cited by 59 publications

(41 citation statements)

References 50 publications

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“…Two other small studies found no association between CPAP use and depression [60,61]. In a recent study, the investigators conducted 1 week of home-based auto-PAP titration and monitored adherence objectively on 240 CPAP-naïve OSA patients [62]. Multiple linear regression analysis revealed that depression significantly predicted fewer hours of auto-PAP use [62].…”

Section: Relationship Between Depression and Cpap Adherencementioning

confidence: 97%

“…In a recent study, the investigators conducted 1 week of home-based auto-PAP titration and monitored adherence objectively on 240 CPAP-naïve OSA patients [62]. Multiple linear regression analysis revealed that depression significantly predicted fewer hours of auto-PAP use [62]. However, most of the previous studies did not control for confounders, such as OSA symptoms (e.g., daytime sleepiness), comorbid conditions of OSA and depression (e.g., insomnia and anxiety), or use and compliance with antidepressant medications which may influence CPAP adherence.…”

Section: Relationship Between Depression and Cpap Adherencementioning

confidence: 99%

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Comorbid depression in obstructive sleep apnea: an under-recognized association

et al. 2015

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Section: Relationship Between Depression and Cpap Adherencementioning

confidence: 97%

Section: Relationship Between Depression and Cpap Adherencementioning

confidence: 99%

Comorbid depression in obstructive sleep apnea: an under-recognized association

et al. 2015

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“…This decision was based on research indicating a steadily increasing incidence of OSA in US veterans; most recent estimates show that the prevalence of OSA among veterans treated in the VA system ranges from 3% to 8% . Although there are no population‐based studies of PAP compliance in veterans, these patients reportedly have a high prevalence of comorbid depression, anxiety, poverty, and post‐traumatic stress disorder, all of which are associated with reduced PAP adherence, suggesting that many veterans might be potential candidates for HGNS therapy . Once the Inspire HGNS was placed on the Federal Supply Schedule, indications for its use are determined by VA treating physicians (both otolaryngology and sleep medicine) in collaboration with the patient.…”

Section: Introductionmentioning

confidence: 99%

Hypoglossal Nerve Stimulator Outcomes for Patients Outside the U.S. FDA Recommendations

et al. 2019

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Objectives The hypoglossal nerve stimulator (HGNS) is currently approved for the treatment of obstructive sleep apnea (OSA) in patients with an apnea‐hypopnea index (AHI) of >15 to ≤65 events/hour, and a central apnea index (CAI) <25% of the AHI, no complete concentric collapse on drug‐induced sleep endoscopy, and a recommended body mass index (BMI) <32 kg/m2. We present 18 patients implanted as a salvage procedure despite being outside these guidelines. Methods We included all patients who underwent HGNS but who did not meet all FDA guidelines. Demographic data, previous OSA treatments, polysomnographic (PSG) parameters from baseline and HGNS titration PSG, Epworth sleepiness score (ESS), and BMI were compared before and after surgery. Results Eighteen patients were identified: 94.4% male, median age 63 years. Seven underwent previous sleep surgery. Four had an AHI <15 (mean 10.5 events/hour), four had an AHI >65 (mean 86.9 events/hour), two had an elevated CAI (mean 31.3% of AHI), and 12 had a BMI >32 kg/m2 (range 32.1–39.1). Median AHI decreased from 25.3 to 3.75 events/hour on titration polysomnography (P = .0006), oxyhemoglobin saturation nadir increased from 82% to 88.5% (P = .0001) and median ESS dropped from 11 to 7.5 (P = .0016). Fifteen (83.3%) patients achieved surgical success (decrease in AHI >50% and AHI <20 events/hour) and 12 (66.7%) had an AHI <5 events/hour. Neither patient with CAI >25% was successfully treated. Median adherence = 33.5 hours/week. Conclusion Our success rate for patients outside the Food and Drug Administration guidelines for HGNS (67%) was similar to the 1‐year STAR trial results (66%). Future studies are necessary to consider expansion of these guidelines. Level of Evidence 4 Laryngoscope, 130:866–872, 2020

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“…Results regarding the effect of depression on PAP adherence are inconsistent, 6 but a recent study indicated that depressed patients with OSA might have poorer compliance with PAP treatment. 36 Furthermore, a number of studies have indicated a bidirectional relationship between poor sleep and depression; some have suggested that sleep difficulties may lead to or exacerbate depression and that by improving sleep quality it is possible to improve symptoms of depression as well. 37,38 OSA severity was not related to depression in our study and others have reported similar results, suggesting that depression is more related to disrupted sleep and sleepiness than OSA severity per se.…”

Section: Table 4-predictivementioning

confidence: 99%

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

Björnsdóttir

Benediktsdóttir

Pack

et al. 2016

Journal of Clinical Sleep Medicine

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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.

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Depression May Reduce Adherence during CPAP Titration Trial

Cited by 59 publications

References 50 publications

Comorbid depression in obstructive sleep apnea: an under-recognized association

Comorbid depression in obstructive sleep apnea: an under-recognized association

Hypoglossal Nerve Stimulator Outcomes for Patients Outside the U.S. FDA Recommendations

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

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