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Meta-Analysis
. 2024 Dec 27;29(1):64.
doi: 10.1007/s11325-024-03235-6.

Depressive symptoms after surgical and medical management of OSA: a systematic review and meta-analysis

Alejandro R Marrero-Gonzalez  1   2 , Craig D Salvador  1 , Shaun A Nguyen  1 , Ted A Meyer  1 , Dee W Ford  3 , Andrea M Rinn  3 , Chitra Lal  3 , Melissa Swanson  4 , Mohamed Abdelwahab  5   6
Affiliations
Meta-Analysis

Depressive symptoms after surgical and medical management of OSA: a systematic review and meta-analysis

Alejandro R Marrero-Gonzalez et al. Sleep Breath. .

Abstract

Purpose: To evaluate the effect of CPAP and surgical alternatives for OSA on depression and compare the results of surgery to CPAP. ​METHODS: COCHRANE Library, CINAHL, PubMed, and Scopus databases were searched for English-language articles. Meta-analysis of continuous measures (mean), proportions (%), and mean difference (Δ) with 95% confidence interval was conducted for objective and subjective outcomes before and after treatment with CPAP or surgical interventions.

Results: We identified 2018 abstracts, 14 studies (N = 3,488) were included in the meta-analysis. Both treatments witnessed significant improvement in Apnea-hypopnea Index (AHI), with similar improvement with CPAP (Δ-48.8 [-51.2, -46.4]) and surgical interventions (Δ -20.22 [-31.3, -9.17]). An improvement in Epworth Sleepiness Scale (ESS) was noted between groups with (Δ -3.9 [-6.2, -1.6]) for the CPAP group and (Δ -4.3 [-6.0, -2.5]) for surgical interventions. The improvement of BDI II depression scores pre- and post-treatment was comparable between treatments with (Δ -4.1 [-5.8, -2.4]) for the CPAP group and (Δ- 5.6 [-9.2, -2.0]) for surgical interventions.

Conclusion: Our findings suggest a reduction in AHI is seen in both CPAP and surgical interventions for OSA, with no difference in AHI reduction between groups. Both treatments also lead to a similar improvement in depression scores providing strong evidence regards impact of surgery on OSA-associated mood disorders. While percent reduction in depression is higher in the surgical group, the difference did not reach statistical significance when compared to CPAP. When stratified by surgical intervention, most interventions suggest an improvement in depression scores.

Keywords: CPAP; Depression; OSA; Sleep surgery.

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Conflict of interest statement

Declarations. Ethical approval: All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research at Medical University of South Carolina and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. For this type of study formal consent is not required. Conflict of interest: All authors certify that they have no affiliations with or involvement in any organization or entity with any financial interest (such as honoraria; educational grants; participation in speakers’ bureaus; membership, employment, consultancies, stock ownership, or other equity interest; and expert testimony or patent-licensing arrangements), or non-financial interest (such as personal or professional relationships, affiliations, knowledge or beliefs) in the subject matter or materials discussed in this manuscript.

Figures

Fig. 1
Fig. 1
Preferred rEporting Items for Systematic Reviews and Meta-analyses (PRISMA) diagram
Fig. 2
Fig. 2
Forest plot of mean difference (MD) on the Apnea-Hypnea Index (AHI) and the Epworth Sleepiness Scale (ESS) from pre and post-treatment. Meta-analysis of AHI. The top panel shows CPAP mean differences in AHI. The bottom panel shows the mean differences in surgical intervention in AHI. CI = confidence interval; IV = inverse variance; CPAP = contnuous positive airway pressure; SD = standard deviation
Fig. 3
Fig. 3
Forest plot of mean difference (MD) on the Beck Depression Index II (BDI-II) from pre and post-treatment. Meta-analysis of BDI. The top panel shows CPAP mean differences in BDI-II. The bottom panel shows surgical intervention mean differences in BDI-II. CI = confidence interval; IV = inverse variance; CPAP = continuous positive airway pressure; SD = standard deviation
Fig. 4
Fig. 4
Forest plot of mean difference (MD) on the Beck Depression Index II (BDI-II) from pre and post-treatment stratified by surgical modality. Meta-analysis of BDI; CI = confidence interval; IV = inverse variance; CPAP = continuous positive airway pressure; SD = standard deviation
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