Clinical depression in untreated obstructive sleep apnea: examining predictors and a meta-analysis of prevalence rates

Melinda L Jackson; Julie Tolson; Delwyn Bartlett; David J Berlowitz; Prerna Varma; Maree Barnes

doi:10.1016/j.sleep.2019.03.011

Clinical depression in untreated obstructive sleep apnea: examining predictors and a meta-analysis of prevalence rates

Sleep Med. 2019 Oct:62:22-28. doi: 10.1016/j.sleep.2019.03.011. Epub 2019 Mar 27.

Authors

Melinda L Jackson¹, Julie Tolson², Delwyn Bartlett³, David J Berlowitz⁴, Prerna Varma⁵, Maree Barnes²

Affiliations

¹ RMIT University, School of Health and Biomedical Science, Bundoora, Melbourne, Australia; Institute for Breathing and Sleep, Austin Health, Heidelberg, Melbourne, Australia. Electronic address: melinda.jackson@monash.edu.
² Institute for Breathing and Sleep, Austin Health, Heidelberg, Melbourne, Australia.
³ Woolcock Institute for Medical Research, Sydney, Australia.
⁴ Institute for Breathing and Sleep, Austin Health, Heidelberg, Melbourne, Australia; The University of Melbourne, Department of Physiotherapy, Austin Health, Heidelberg, Melbourne, Australia.
⁵ RMIT University, School of Health and Biomedical Science, Bundoora, Melbourne, Australia.

PMID: 31525678
DOI: 10.1016/j.sleep.2019.03.011

Abstract

Objective/background: Patients with obstructive sleep apnea (OSA) experience daytime sleepiness, cognitive impairment and depressive symptoms. However, the measured prevalence of clinical depression in OSA using standardized clinical assessment is currently unclear. The aims of this study were to examine the prevalence of clinical depression and antidepressant use in untreated OSA patients, to examine predictors of depression, and to conduct an exploratory meta-analysis to determine the pooled prevalence of clinical depression in this population.

Patients/methods: In sum, 109 consecutive patients with diagnosed OSA (mean age (SD) = 52.6 (12.1) years; 43.1% female) who presented to the sleep laboratory completed a structured clinical interview for depression (SCID-IV), the Hospital Anxiety and Depression Scale, the Pittsburgh Sleep Quality Index (PSQI), the Functional Outcomes of Sleep Questionnaire (FOSQ), the Assessment of Quality of Life Questionnaire (AQoL) and the Epworth Sleepiness Scale (EES). An exploratory meta-analysis was also conducted to quantify the risk of clinical depression in untreated OSA.

Results: Twenty-five (22.7%) participants had clinical depression based on the SCID-IV, and 24.8% were using antidepressants. Those with clinical depression had significantly poorer sleep quality and impaired quality of life. In a regression model, quality of life impairment was most strongly associated with clinical depression. Results from the meta-analysis revealed a pooled prevalence of 23% of clinical depression in OSA patients across seven studies.

Conclusion: Clinical depression and antidepressant use is common in patients with OSA. Depression was associated with reduced quality of life and poorer subjective sleep, however it was not associated with polysomnographic measures or daytime sleepiness. Whether CPAP treatment can alleviate the burden of clinical depression needs to be determined in future studies.

Keywords: Excessive daytime sleepiness; Major depressive disorder; Meta-analysis; Mood; Quality of life; Sleep apnea.

Publication types

Meta-Analysis
Research Support, Non-U.S. Gov't

MeSH terms

Adult
Antidepressive Agents / standards
Antidepressive Agents / therapeutic use
Continuous Positive Airway Pressure / methods
Depressive Disorder, Major / drug therapy
Depressive Disorder, Major / epidemiology*
Depressive Disorder, Major / etiology
Depressive Disorder, Major / psychology*
Disorders of Excessive Somnolence / psychology
Female
Humans
Male
Middle Aged
Mood Disorders / epidemiology
Mood Disorders / psychology
Prevalence
Quality of Life / psychology
Randomized Controlled Trials as Topic
Risk Assessment
Sleep Apnea, Obstructive / complications
Sleep Apnea, Obstructive / psychology*
Sleep Apnea, Obstructive / therapy
Sleep*
Surveys and Questionnaires

Substances

Antidepressive Agents