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. 2015 Sep 15;11(9):1029-38.
doi: 10.5664/jcsm.5020.

Depressive Symptoms before and after Treatment of Obstructive Sleep Apnea in Men and Women

Cass Edwards  1   2   3 , Sutapa Mukherjee  2 , Laila Simpson  2   4   5 , Lyle J Palmer  6 , Osvaldo P Almeida  7 , David R Hillman  1   2   3   5
Affiliations

Depressive Symptoms before and after Treatment of Obstructive Sleep Apnea in Men and Women

Cass Edwards et al. J Clin Sleep Med. .

Abstract

Study objectives: To determine prevalence of depressive symptoms in obstructive sleep apnea (OSA) and the impact of OSA treatment on depression scores.

Methods: Consecutive new patients referred for investigation of suspected OSA were approached. Consenting patients completed a patient health questionnaire (PHQ-9) for depressive symptoms when attending for laboratory polysomnography. Those with moderate/severe (apneahypopnea index [AHI] ≥ 15 events/h) and/or symptomatic mild OSA (AHI 5-14.99 events/h) were offered continuous positive airway pressure (CPAP) therapy. PHQ-9 was repeated after 3 months of CPAP with compliance recorded. Of a maximum PHQ-9 score of 27, a cut point ≥ 10 (PHQ-9 ≥ 10) was used to indicate presence of clinically significant depressive symptoms.

Results: A total of 426 participants (243 males) were recruited. Mean ± standard deviation body mass index (BMI) was 32.1 ± 7.1 kg/m2 and AHI 33.6 ± 28.9 events/h. PHQ-9 was 10.5 ± 6.1 and independently related to AHI (p < 0.001) and BMI (p < 0.001). In those without OSA, PHQ-9 ≥ 10 was more common in women, but no gender difference was evident with OSA. Of 293 patients offered CPAP, 228 were compliant (mean nightly use > 5 h) over 3 months of therapy. In them, with therapy, AHI decreased from 46.7 ± 27.4 to 6.5 ± 1.6 events/h, PHQ-9 from 11.3 ± 6.1 to 3.7 ± 2.9 and PHQ-9 ≥ 10 from 74.6% to 3.9% (p < 0.001 in each case). Magnitude of change in PHQ-9 was similar in men and women. Antidepressant use was constant throughout.

Conclusions: Depressive symptoms are common in OSA and related to its severity. They improve markedly with CPAP, implying a relationship to untreated OSA.

Keywords: continuous positive airway pressure; depression; depressive symptoms; obstructive sleep apnea; patient health questionnaire.

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Figures

Figure 1
Figure 1. Public health questionnaire (PHQ-9).
See this image and copyright information in PMC

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