Surgical treatment of the sleep apnea syndrome reduces associated major depression

Study Objectives: Obstructive sleep apnea (OSA) has been associated with psychiatric pathology. Psychiatric comorbidity in OSA may affect patient quality of life and adherence to CPAP. A focused evaluation of OSA in highly selected groups of primarily psychiatric patients may provide further insights into the factors contributing to comorbidity of OSA and psychopathology. The goal of this study is to examine the prevalence and treatment of OSA in psychiatric populations. Methods: A systematic review following the PRISMA guidelines was conducted to determine the prevalence of OSA in schizophrenia and other psychotic disorders, mood disorders, and anxiety disorders, and to examine potential interventions. The PubMed, EMBASE, and PsycINFO databases were searched (last search April 26, 2014) using keywords based on the ICD-9-CM coding for OSA and the DSM-IV-TR diagnostic groups. Results: The search retrieved 48 records concerning studies of OSA in the selected disorders. The prevalence studies indicate that there may be an increased prevalence of OSA in individuals with major depressive disorder (MDD) and posttraumatic stress disorder (PTSD), despite considerable heterogeneity and a high risk of bias. There was insuffi cient evidence to support increased OSA in schizophrenia and psychotic disorders, bipolar and related disorders, and anxiety disorders other than PTSD. Studies of treatment of OSA indicate an improvement in both OSA and psychiatric symptoms. CPAP adherence was reduced in veterans with PTSD. Conclusions: OSA prevalence may be increased in MDD and PTSD. In individuals with OSA and psychiatric illness, treatment of both disorders should be considered for optimal treatment outcomes. 1 According to a major US study of OSA diagnosed by polysomnography (PSG), the prevalence of OSA, as defi ned by an apnea-hypopnea index (AHI) ≥ 5 and without inclusion of a daytime sleepiness criterion, was reported as 24% for men and 9% for women under the age of 65 years; addition of a daytime sleepiness criterion reduced these estimates to 4% for men and 2% for women. 1,2 OSA is commonly associated with metabolic syndrome including comorbid obesity, hypertension, and diabetes.1 Upper airway obstruction may present as apneas, hypopneas, or respiratory effort-related arousals (RERAs), resulting in oxygen desaturation, repeated arousals and sleep fragmentation. Recently, there has been an increase in reports of comorbidity of OSA with psychological/psychiatric symptoms. Psychiatric comorbidity in OSA has been reported to adversely affect the quality of life of OSA patients and adherence to CPAP therapy. 3-5Psychological symptoms such as depression and anxiety are commonly reported in adults with OSA; however, the relationship between OSA and full psychiatric syndromes is less clear. Global prevalence studies and reviews have suggested that there are elevated rates of psychological symptoms in individuals with OSA. [17][18][19] Studies that have evaluated the prevalence of OSA in the highly selected groups of psychiatric popu...

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“…[60][61][62][63][64][65][66][67] A single study examined the effect UPPP on patients with a current major depressive episode (MDE).…”

Section: Mood Disordersmentioning

confidence: 99%

Obstructive Sleep Apnea and Psychiatric Disorders: A Systematic Review

Gupta

Simpson

2015

Journal of Clinical Sleep Medicine

260

156

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“…7,11,14,[21][22][23][24][25][26][27] Mood improvements have been detected as early as 1 month post-treatment 22,28,29 and are maintained for the long term. 20,34 Of note, many symptoms of clinical depression (e.g., sleep problems, fatigue, concentration difficulties, irritability, social withdrawal) overlap with symptoms of OSA. [31][32][33] Depressive symptoms in OSA patients may be an emotional reaction to having a chronic medical illness or perhaps the result of the excessive sleepiness and hypoxemia characteristic of OSA.…”

mentioning

confidence: 99%

Changes in Depressive Symptoms after Continuous Positive Airway Pressure Treatment for Obstructive Sleep Apnea

Means¹,

Lichstein

Edinger

et al. 2003

Sleep Breath

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It is generally believed that obstructive sleep apnea (OSA) causes depression in some patients, yet it is unknown whether this depression is an actual clinical phenomenon or purely a result of overlapping somatic/physical symptoms shared by both disorders. The present study investigated changes in both somatic and affective/cognitive symptoms of depression associated with the introduction of continuous positive airway pressure (CPAP) treatment for OSA. Participants were 39 outpatients (35 males, 4 females) with no current or past mental health problems, diagnosed with OSA in a hospital sleep disorders clinic. The Beck Depression Inventory (BDI) was administered prior to treatment and again 3 months after CPAP. Total BDI scores improved after CPAP, independent of objectively monitored CPAP compliance rates. Both somatic and affective/ cognitive symptoms of depression improved in a similar manner after treatment. Our findings suggest that depressive symptoms experienced by OSA patients are not solely the result of physical OSA symptoms but include a mood component as well. We introduce a hypothetical model to conceptualize the relationship between OSA and depression.

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“…Pseudo-depression/distress is not uncommon in CHF populations and will sometimes result in the Behavioral Cardiology Specialist requesting further medical workups, or treatment/modification of treatment of a comorbid medical condition that mimics/causes depression/distress [24-27, [65][66][67]. Most common in the CHF population are:…”

Section: Differential Diagnosismentioning

confidence: 99%

Screening, diagnosis & monitoring of depression/distress in CHF patients

Ketterer

Knysz

2007

Heart Fail Rev

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Objective and validated measures of depression/distress (anxiety and anger) are available and readily usable at the bedside or in clinic. Foremost among these is the Patient's Health Questionnaire--an adaptation of DSM IV criteria for Major Depressive Disorder that permits administration and scoring by nursing or physician personnel, and quantification of the intensity of depression. A score of 10 or greater indicates a need for evaluation/treatment. Because of patient denial/minimization/alexithymia, PHQ negatives should undergo further screening by having a spouse or friend complete a depression/distress rating scale. The only standardized, normed, and validated spouse/friend scale presently available is the Ketterer Stress Symptom Frequency Checklist, which is available by internet.

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Surgical treatment of the sleep apnea syndrome reduces associated major depression

Cited by 27 publications

References 23 publications

Obstructive Sleep Apnea and Psychiatric Disorders: A Systematic Review

Obstructive Sleep Apnea and Psychiatric Disorders: A Systematic Review

Changes in Depressive Symptoms after Continuous Positive Airway Pressure Treatment for Obstructive Sleep Apnea

Screening, diagnosis & monitoring of depression/distress in CHF patients

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