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

Abstract

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.

Higher Risk for Obstructive Sleep Apnea in Chronic Treatment-Resistant Depression

“…The main finding is consistent with studies reporting an increased incidence of OSA symptoms in patients with depression, building a long-standing co-occurrence of mood and sleep disorders (11,24). The results are also consistent with studies indicating that untreated OSA patients might show higher depressive symptoms (38)(39)(40). Several studies have shown that existence of treatment resistant symptoms in patients with OSA might be due to depression and not due to OSA per se (41)(42)(43).…”

Increased severity of obstructive sleep apnea is associated with less anxiety and depression

“…Other studies have produced conflicting results regarding the association between OSA severity and mental disorders (Bahammam et al ., ). In an Icelandic study (Bjornsdottir et al ., ), no association was found between AHI or oxygen desaturation index and depression diagnosed with the Mini International Neuropsychiatric Interview. Similarly, an American study did not find any association between OSA severity and depression or anxiety when assessing the two latter constructs with the Beck Depression Inventory and the Beck Anxiety Inventory, respectively (Macey et al ., ).…”

“…However, several other studies have failed to find an association between OSA severity and the prevalence of depression and anxiety (Bjornsdottir et al ., ; Douglas et al ., ; Macey et al ., ). A methodological limitation of the aforementioned studies is that they were based on small samples, ranging from 49 to 426 participants (Bjornsdottir et al ., ; Douglas et al ., ; Edwards et al ., ; Macey et al ., ). Furthermore, in a study among 825 elderly people (aged ≥ 65 years), neither the presence nor the severity of OSA were associated significantly with depression or anxiety.…”

Co‐morbid OSA and insomnia increases depression prevalence and severity in men

“…Patients with co‐morbid OSA and insomnia may have more alterations in nocturnal sleep but do not have a greater cardiovascular risk than patients with OSA alone . Co‐morbid OSA and insomnia patients do consistently report higher rates of psychiatric disorders, anxiety and depression than OSA patients without insomnia in sleep clinic studies . In contrast, a large retrospective case–control study of ambulatory databases based on healthcare visits to physicians and hospital departments in the United States found no association between co‐morbid OSA and insomnia and physician‐rated psychiatric syndromes .…”