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DOI: 10.1055/s-2003-38945
Changes in Depressive Symptoms after Continuous Positive Airway Pressure Treatment for Obstructive Sleep Apnea
Publication History
Publication Date:
24 April 2003 (online)
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ABSTRACT
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.
KEYWORDS
Sleep apnea - depression - CPAP
REFERENCES
- 1 Bassiri A G, Guilleminault C. Clinical features and evaluation of obstructive sleep apnea-hypopnea syndrome. In: Dement WC, ed. Principles and Practice of Sleep Medicine 3rd ed. Philadelphia: WB Saunders 2000 : 869-878
- 2 Young T, Palta M, Dempsey J. et al . The occurrence of sleep-disordered breathing among middle-aged adults. New Engl J Med . 1993; 328 1230-1235
- 3 Day R, Gerhardstein R, Lumley A, Roth T, Rosenthal L. The behavioral morbidity of obstructive sleep apnea. Prog Cardiovasc Dis . 1999; 41 341-354
- 4 Baldwin C M, Griffith K A, Nieto F J. et al . The association of sleep-disordered breathing and sleep symptoms with quality of life in the Sleep Heart Health Study. Sleep . 2001; 24 96-105
- 5 Engleman H M, Kingshott R N, Wraith P K. et al . Randomized placebo-controlled crossover trial of continuous positive airway pressure for mild sleep apnea/hypopnea syndrome. Am J Respir Crit Care Med . 1999; 159 461-467
- 6 Aikens J E, Caruana-Montaldo B, Vanable P A, Tadimeti L, Mendelson W B. Depression and general psychopathology in obstructive sleep apnea. Sleep . 1998; 21 71
- 7 Millman R P, Fogel B S, McNamara M E, Carlisle C C. Depression as a manifestation of obstructive sleep apnea: reversal with nasal continuous positive airway pressure. J Clin Psychiatry . 1989; 50 348-351
- 8 Mosko S, Zetin M, Glen S. et al . Self-reported depressive symptomatology, mood ratings, and treatment outcome in sleep disorders patients. J Clin Psychol . 1989; 45 51-60
- 9 Nambu Y, Nagasaka Y, Fujita E, Hamada S, Fukuoka M. Effect of mandibular advancement splint on psycho-intellectual derangements in patients with sleep apnea syndrome. Tohoku J Exp Med . 1999; 188 119-132
- 10 Reynolds 3rd F C, Kupfer D J, McEachran A B. et al . Depressive psychopathology in male sleep apneics. J Clin Psychiatry . 1984; 45 287-290
- 11 Yamamoto H, Akashiba T, Kosaka N, Ito D, Horie T. Long-term effects of nasal continuous positive airway pressure on daytime sleepiness, mood and traffic accidents in patients with obstructive sleep apnoea. Respir Med . 2000; 94 87-90
- 12 Cheshire K, Engleman H, Deary I, Shapiro C, Douglas N J. Factors impairing daytime performance in patients with sleep apnea/hypopnea syndrome. Arch Intern Med . 1992; 152 538-541
- 13 Kales A, Caldwell A B, Cadieux R J. et al . Severe obstructive sleep apnea-II: associated psychopathology and psychosocial consequences. J Chronic Dis . 1985; 38 427-434
- 14 Meslier N, Lebrun T, Grillier-Lanoir V. et al . A French survey of 3,225 patients treated with CPAP for obstructive sleep apnoea: benefits, tolerance, compliance and quality of life. Eur Respir J . 1998; 12 185-192
- 15 Bliwise D L, Yesavage J A, Sink J, Widrow L, Dement W C. Depressive symptoms and impaired respiration in sleep. J Consult Clin Psychol . 1986; 54 734-735
- 16 Sink J, Bliwise D L, Dement W C. Self-reported excessive daytime somnolence and impaired respiration in sleep. Chest . 1986; 90 177-180
- 17 Gall R, Isaac L, Kryger M. Quality of life in mild obstructive sleep apnea. Sleep . 1993; 16 S59-61
- 18 Pillar G, Lavie P. Psychiatric symptoms in sleep apnea syndrome: effects of gender and respiratory disturbance index. Chest . 1998; 114 697-703
- 19 Maczaj M, Kapuria S, Pieczalski M. et al . Use of the SCID as an objective measure for evaluating the prevalence of depression in patients with OSAS. Sleep . 2000; 23 A365
- 20 Dahlof P, Ejnell H, Hallstrom T, Hedner J. Surgical treatment of the sleep apnea syndrome reduces associated major depression. Int J Behav Med . 2000; 7 73-88
- 21 Borak J, Cieslicki J, Szelenberger W. et al . Psychopathological characteristics of the consequences of obstructive sleep apnea prior to and three months after CPAP. Psychiatria Polska . 1994; 28 33-44
- 22 Charbonneau M, Tousignant P, Lamping D L. et al . The effects of nasal continuous positive airway pressure (nCPAP) on sleepiness and psychological functioning in obstructive sleep apnea (OSA). Am Rev Respir Dis . 1992; 145 A168
- 23 Derderian S S, Bridenbaugh R H, Rajagopal K R. Neuropsychologic symptoms in obstructive sleep apnea improve after treatment with nasal continuous positive airway pressure. Chest . 1988; 94 1023-1027
- 24 Douglas N J, Engleman H M. Effects of CPAP on vigilance and related functions in patients with the sleep apnea/ hypopnea syndrome. Sleep . 2000; 23 S147-149
- 25 Mayleben D W, Scharf M B, Sachais B A. Change in MMPI factors in patients undergoing prolonged CPAP treatment for obstructive sleep apnea. Sleep Res . 1990; 19 252
- 26 Engleman H M, Cheshire K E, Deary I J, Douglas N J. Daytime sleepiness, cognitive performance and mood after continuous positive airway pressure for the sleep apnoea/ hypopnoea syndrome. Thorax . 1993; 48 911-914
- 27 Ramos-Platon M J, Sierra J E. Changes in psychopathological symptoms in sleep apnea patients after treatment with nasal continuous positive airway pressure. Int J Neurosci . 1992; 62 173-195
- 28 Engleman H M, Martin S E, Deary I J, Douglas N J. Effect of CPAP therapy on daytime function in patients with mild sleep apnoea/hypopnoea syndrome. Thorax . 1997; 52 114-119
- 29 Engleman H M, Martin S E, Deary I J, Douglas N J. Effect of continuous positive airway pressure treatment on daytime function in sleep apnoea/hypopnoea syndrome. Lancet . 1994; 343 572-575
- 30 Kingshott R N, Vennelle M, Hoy C J. et al . Predictors of improvements in daytime function outcomes with CPAP therapy. Am J Respir Crit Care Med . 2000; 161 866-871
- 31 Borak J, Cieslicki J K, Koziej M, Matuszewski A, Zielinski J. Effects of CPAP treatment on psychological status in patients with severe obstructive sleep apnoea. J Sleep Res . 1996; 5 123-127
- 32 Engleman H M, Martin S E, Kingshott R N. et al . Randomised placebo controlled trial of daytime function after continuous positive airway pressure (CPAP) therapy for the sleep apnoea/hypopnoea syndrome. Thorax . 1998; 53 341-345
- 33 Munoz A, Mayoralas L R, Barbe F, Pericas J, Agusti A G. Long-term effects of CPAP on daytime functioning in patients with sleep apnoea syndrome. Eur Respir J . 2000; 15 676-681
- 34 Wright J, White J. Continuous positive airways pressure for obstructive sleep apnea (Cochrane Review). In: The Cochrane Library, Issue 1, Oxford; Update Software
- 35 Kaplan R. Obstructive sleep apnoea and depression-diagnostic and treatment implications. Aust N Z J Psychiatry . 1992; 26 586-591
- 36 Lee S. Depression in sleep apnea: a different view. J Clin Psychiatry . 1990; 51 309-310
- 37 Lee S, Wing Y K, Chen C N. Obstructive sleep apnoea and depression. Aust N Z J Psychiatry . 1993; 27 162-166
- 38 Cavanaugh S V. Diagnosing depression in the hospitalized patient with chronic medical illness. J Clin Psychiatry . 1984; 45 13-17
- 39 Koenig H G, Cohen H J, Blazer D G, Krishnan K R, Sibert T E. Profile of depressive symptoms in younger and older medical inpatients with major depression. J Am Geriatr Soc . 1993; 41 1169-1176
- 40 Aikens J E, Mendelson W B. A matched comparison of MMPI responses in patients with primary snoring or obstructive sleep apnea. Sleep . 1999; 22 355-359
- 41 Bardwell W A, Moore P, Ancoli-Israel S, Dimsdale J E. Does obstructive sleep apnea confound sleep architecture findings in subjects with depressive symptoms?. Biol Psychiatry . 2000; 48 1001-1009
- 42 Berry D TR, Phillips B A, Cook Y R. et al . Geriatric sleep apnea syndrome: a preliminary description. J Gerontol . 1990; 45 M169-M174
- 43 Beck A T, Rush A J, Shaw B F, Emery G. Cognitive Therapy of Depression. New York: Guilford Press; 1979
- 44 Tanaka J S, Huba G J. Confirmatory hierarchical factor analyses of psychological distress measures. J Pers Soc Psychol . 1984; 46 621-635
- 45 Neimeyer R A, Baker K D, Haykal R F, Akiskal H S. Patterns of symptomatic change in depressed patients in a private inpatient mood disorders program. Bull Menninger Clin . 1995; 59 460-471
- 46 Barbe F, Pericas J, Munoz A. et al . Automobile accidents in patients with sleep apnea syndrome. An epidemiological and mechanistic study. Am J Respir Crit Care Med . 1998; 158 18-22
- 47 Barnes M, McEvoy R D, Pierce R J. Neurobehavioural impairment in mild sleep apnea patients compared to control subjects. Sleep . 2001; 24 A276
- 48 Yang C K, Clerk A, Shin H R. Depression, perceived stress, and coping strategies of patients with sleep-related breathing disorder. Sleep . 1998; 21 74
- 49 Watson R, Greenberg G, Bakos L. Sleep apnea and depression. Sleep Res . 1987; 16 293
- 50 McCullogh P A. Obstructive Sleep Apnea: Does Level of Severity Correlate with Level of Depression?. [master's thesis] Louisville, KY: University of Louisville; 1997
- 51 Klonoff H, Fleetham J, Taylor D R, Clark C. Treatment outcome of obstructive sleep apnea. Physiological and neuropsychological concomitants. J Nerv Ment Dis . 1987; 175 208-212
- 52 Rechtschaffen A, Kales A. A Manual of Standardized Terminology, Techniques, and Scoring System for Sleep Stages of Human Subjects. Los Angeles: Brain Information Service/Brain Research Inst, University of California; 1968
- 53 Beck A T, Steer R A, Garbin M G. Psychometric properties of the Beck Depression Inventory: twenty-five years of evaluation. Clin Psychol Rev . 1988; 8 77-100
- 54 Richter P, Werner J, Heerlein A, Kraus A, Sauer H. On the validity of the Beck Depression Inventory. A review. Psychopathology . 1998; 31 160-168
- 55 Katz R, Katz J, Shaw B F. Beck Depression Inventory and hopelessness scale. In: Maruish ME, ed. The Use of Psychological Testing for Treatment Planning and Outcome Assessment Hillsdale, NJ: Lawrence Erlbaum 1994: 279-291
- 56 Krieger J, Kurtz D, Petiau C, Sforza E, Trautmann D. Long-term compliance with CPAP therapy in obstructive sleep apnea patients and in snorers. Sleep . 1996; 19 S136-143
- 57 American Academy of Sleep Medicine. Sleep-related breathing disorders in adults: recommendations for syndrome definition and measurement techniques in clinical research. The report of an American Academy of Sleep Medicine Task Force. Sleep . 1999; 22 667-689
- 58 National Heart Lung and Blood Institute. Clinical guidelines on the identification, evaluation, and treatment of overweight and obesity in adults. Bethesda, MD: National Institutes of Health. 1998; xi-xxxx
- 59 Herdegen J J, Clark L J, Stepanski E J. et al . Treating sleep-disordered breathing: a longitudinal analysis of patient characteristics and positive airway pressure compliance. Sleep . 2000; 23 A82
- 60 Rosenthal L, Gerhardstein R, Lumley A. et al . CPAP therapy in patients with mild OSA: implementation and treatment outcome. Sleep Med . 2000; 1 215-220
- 61 Barbe F, Mayoralas L R, Duran J. et al . Treatment with continuous positive airway pressure is not effective in patients with sleep apnea but no daytime sleepiness. A randomized, controlled trial. Ann Intern Med . 2001; 134 1015-1023
- 62 Engleman H M, Martin S E, Douglas N J. Compliance with CPAP therapy in patients with the sleep apnoea/hypopnoea syndrome. Thorax . 1994; 49 263-266
- 63 Reeves-Hoche M K, Meck R, Zwillich C W. Nasal CPAP: an objective evaluation of patient compliance. Am J Respir Crit Care Med . 1994; 149 149-154
- 64 Weaver T E, Kribbs N B, Pack A I. et al . Night-to-night variability in CPAP use over the first three months of treatment. Sleep . 1997; 20 278-283
- 65 Greenham-Conway B, Michalow B, Potaski C, Mouton A. Subjective changes in mood and daytime sleepiness in apnea patients treated with nasal CPAP. Sleep . 2000; 23 A80-81
- 66 Hers V, Liistro G, Dury M. et al . Residual effect of nCPAP applied for part of the night in patients with obstructive sleep apnoea. Eur Respir J . 1997; 10 973-976
- 67 Yu B H, Ancoli-Israel S, Dimsdale J E. Effect of CPAP treatment on mood states in patients with sleep apnea. J Psychiatr Res . 1999; 33 427-432