DEPRESSION SEVERITY AND OBSTRUCTIVE SLEEP APNEA IN OLDER ADULTS

Abstract Objective: The connection between obstructive sleep apnea and depression in older adults is well documented; however, to date the relationship between severity of these depressive symptoms in this population remains under-explored. As such, the current analysis examined a potential relationship between varying levels of depression severity among older adults with sleep apnea. Participants and Methods: Data was derived from a de-identified database of older adults (age>=65) from the National Alzheimer’s Coordinating Center (NACC). The sample (N=90; 50% female; 97.8% Caucasian; Mage=77 years; SDage=10.4 years) was sorted into three groups using the Neuropsychiatric Inventory Questionnaire (NPI-Q): 1) Mild Depression [n=56], 2) Moderate Depression [n=29], and 3) Severe Depression [n=5]. Results: A univariate analysis revealed an overall significant omnibus effect between sleep apnea and depression severity (F[2,4041])=16.231, p<.001), while controlling for age, race, and sex. Post-hoc comparison found that those with severe depression had significantly higher levels of sleep apnea compared to those with mild (Mdif =-.499, p = .029) and moderate (Mdif =-.597, p = .009). Conclusions: These data support the possible association between depression severity and obstructive sleep apnea. Results may be attributable to two different theories: that low serotonin levels may simultaneously influence depression, respiratory muscle-tone, and sleep disturbance, and that intermittent hypoxia may create a cascade effect of neurovascular pathology resulting in depressive symptoms. Implications of the current findings suggest it may prove beneficial to keep in mind the risks associated with sleep apnea, and more severe depression, should an individual present with either.

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Obstructive Sleep Apnea (OSA) and depressive symptoms

Arquivos de Neuro-Psiquiatria ◽

10.1590/s0004-282x2009000100009 ◽

2009 ◽

Vol 67 (1) ◽

pp. 35-39 ◽

Cited By ~ 13

Author(s):

Michele Dominici ◽

Marleide da Mota Gomes

Keyword(s):

Obstructive Sleep Apnea ◽

Depressive Symptoms ◽

Sleep Apnea ◽

Statistical Significance ◽

Univariate Analysis ◽

Multivariate Logistic Regression Analysis ◽

Apnea Hypopnea Index ◽

Analysis Model ◽

Cross Sectional ◽

Obstructive Sleep

BACKGROUND: The relationship between obstructive sleep apnea (OSA) and depressive symptoms is ambiguous in the literature. PURPOSE: To investigate if there is a correlation between depressive symptoms and the severity of OSA. METHOD: A retrospective, cross-sectional study of data from 123 consecutive adults patients with neither mental illness nor psychotropic drugs intake, referred to a sleep laboratory for an evaluation of OSA. For the statistical analysis (uni- and multivariate), we used the following variables: gender and age, as well as scores based on several scales and indexes such as Beck Depressive Inventory (BDI), Epworth Sleepiness Scale (ESS), Body Mass Index (BMI) and Apnea-Hypopnea Index (AHI). RESULTS: Univariate analysis found a weak but statistically significant negative correlation between BDI and AHI. However, with the multivariate logistic regression analysis model, the inverse relation between AHI and BDI no longer has statistical significance. CONCLUSION: There is no causal relationship between OSA and depressive symptoms in the population studied.

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Development of a pediatric obstructive sleep apnea triage algorithm

Journal of Otolaryngology - Head and Neck Surgery ◽

10.1186/s40463-021-00528-8 ◽

2021 ◽

Vol 50 (1) ◽

Author(s):

D. S. Heath ◽

H. El-Hakim ◽

Y. Al-Rahji ◽

E. Eksteen ◽

T. C. Uwiera ◽

...

Keyword(s):

Obstructive Sleep Apnea ◽

Sleep Apnea ◽

Univariate Analysis ◽

Individual Risk ◽

Obstructive Sleep ◽

High Prevalence ◽

Grade Scale ◽

Overnight Oximetry ◽

Triage Algorithm ◽

Pediatric Sleep

Abstract Introduction Diagnosis and treatment of obstructive sleep apnea (OSA) in children is often delayed due to the high prevalence and limited physician and sleep testing resources. As a result, children may be referred to multiple specialties, such as pediatric sleep medicine and pediatric otolaryngology, resulting in long waitlists. Method We used data from our pediatric OSA clinic to identify predictors of tonsillectomy and/or adenoidectomy (AT). Before being seen in the clinic, parents completed the Pediatric Sleep Questionnaire (PSQ) and screening questionnaires for restless leg syndrome (RLS), nasal rhinitis, and gastroesophageal reflux disease (GERD). Tonsil size data were obtained from patient charts and graded using the Brodsky-five grade scale. Children completed an overnight oximetry study before being seen in the clinic, and a McGill oximetry score (MOS) was assigned based on the number and depth of oxygen desaturations. Logistic regression, controlling for otolaryngology physician, was used to identify significant predictors of AT. Three triage algorithms were subsequently generated based on the univariate and multivariate results to predict AT. Results From the OSA cohort, there were 469 eligible children (47% female, mean age = 8.19 years, SD = 3.59), with 89% of children reported snoring. Significant predictors of AT in univariate analysis included tonsil size and four PSQ questions, (1) struggles to breathe at night, (2) apneas, (3) daytime mouth breathing, and (4) AM dry mouth. The first triage algorithm, only using the four PSQ questions, had an odds ratio (OR) of 4.02 for predicting AT (sensitivity = 0.28, specificity = 0.91). Using only tonsil size, the second algorithm had an OR to predict AT of 9.11 (sensitivity = 0.72, specificity = 0.78). The third algorithm, where MOS was used to stratify risk for AT among those children with 2+ tonsils, had the same OR, sensitivity, and specificity as the tonsil-only algorithm. Conclusion Tonsil size was the strongest predictor of AT, while oximetry helped stratify individual risk for AT. We recommend that referral letters for snoring children include graded tonsil size to aid in the triage based on our findings. Children with 2+ tonsil sizes should be triaged to otolaryngology, while the remainder should be referred to a pediatric sleep specialist. Graphical abstract

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Stress in obstructive sleep apnea

Scientific Reports ◽

10.1038/s41598-021-91996-5 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Jasmine L. Wong ◽

Fernando Martinez ◽

Andrea P. Aguila ◽

Amrita Pal ◽

Ravi S. Aysola ◽

...

Keyword(s):

Obstructive Sleep Apnea ◽

Depressive Symptoms ◽

Sleep Apnea ◽

Perceived Stress ◽

Stress Reduction ◽

Psychological Symptoms ◽

Cross Sectional Study ◽

Cross Sectional ◽

General Anxiety Disorder ◽

Obstructive Sleep

AbstractPeople with obstructive sleep apnea (OSA) often have psychological symptoms including depression and anxiety, which are commonly treated with anti-depression or anti-anxiety interventions. Psychological stress is a related symptom with different intervention targets that may also improve mental state, but this symptom is not well characterized in OSA. We therefore aimed to describe stress in relation to other psychological symptoms. We performed a prospective cross-sectional study of 103 people, 44 untreated OSA (mean ± s.d. age: 51.2 ± 13.9 years, female/male 13/31) and 57 healthy control participants (age: 46.3 ± 13.8 years, female/male 34/23). We measured stress (Perceived Stress Scale; PSS), excessive daytime sleepiness (Epworth Sleepiness Scale; ESS), depressive symptoms (Patient Health Questionnaire; PHQ-9), and anxiety symptoms (General Anxiety Disorder; GAD-7). We compared group means with independent samples t-tests and calculated correlations between variables. Mean symptom levels were higher in OSA than control, including PSS (mean ± s.d.: OSA = 15.3 ± 6.9, control = 11.4 ± 5.5; P = 0.002), GAD-7 (OSA = 4.8 ± 5.0, control = 2.1 ± 3.9; P = 0.02), PHQ-9 (OSA = 6.9 ± 6.1, control = 2.6 ± 3.8; P = 0.003) and ESS (OSA = 8.1 ± 5.3, control = 5.0 ± 3.3; P = 0.03). Similar OSA-vs-control differences appeared in males, but females only showed significant differences in PHQ-9 and ESS, not PSS or GAD-7. PSS correlated strongly with GAD-7 and PHQ-9 across groups (R = 0.62–0.89), and moderately with ESS. Perceived stress is high in OSA, and closely related to anxiety and depressive symptoms. The findings support testing stress reduction in OSA.

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Risk of obstructive sleep apnea, excessive daytime sleepiness and depressive symptoms in a Nigerian elderly population

Sleep Science ◽

10.1016/j.slsci.2016.05.005 ◽

2016 ◽

Vol 9 (2) ◽

pp. 106-111 ◽

Cited By ~ 3

Author(s):

Michael B. Fawale ◽

Olanrewaju Ibigbami ◽

Ishaq Ismail ◽

Adekunle F. Mustapha ◽

Morenikeji A. Komolafe ◽

...

Keyword(s):

Obstructive Sleep Apnea ◽

Depressive Symptoms ◽

Sleep Apnea ◽

Excessive Daytime Sleepiness ◽

Daytime Sleepiness ◽

Elderly Population ◽

Obstructive Sleep

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Depressive Symptoms in Comorbid Obstructive Sleep Apnea and Insomnia: An Integrative Review

Western Journal of Nursing Research ◽

10.1177/0193945921989656 ◽

2021 ◽

pp. 019394592198965

Author(s):

Bomin Jeon ◽

Faith S. Luyster ◽

Judith A. Callan ◽

Eileen R. Chasens

Keyword(s):

Obstructive Sleep Apnea ◽

Depressive Symptoms ◽

Sleep Apnea ◽

Control Design ◽

Case Control ◽

Integrative Review ◽

Study Quality ◽

Cross Sectional ◽

Obstructive Sleep ◽

The Relationship

The purpose of this integrative review was to synthesize evidence concerning the relationship between comorbid obstructive sleep apnea and insomnia (OSA+I), and depressive symptoms. OSA and insomnia are common sleep disorders, recently comorbid OSA+I has been recognized as prevalent in adults. Although each sleep disorder increases the risk and severity of depressive symptoms, the effect of comorbid OSA+I on depressive symptoms remains unclear. A systematic search of PubMed, CINAHL, and PsycINFO identified 15 data-based studies. All the studies were observational with either a cross-sectional (n = 14) or a case-control design (n = 1). Study quality was assessed. Most of the studies (n = 14) indicated that comorbid OSA+I had an additive role on depressive symptoms. Insomnia appeared to have a more important role than OSA in increasing the severity of depressive symptoms in persons with comorbid OSA+I.

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