Download PDF
Sleep Breath 2003; 07(1): 031-042
DOI: 10.1055/s-2003-38945
Copyright © 2003 by Thieme Medical Publishers, Inc., 333 Seventh Avenue, New York, NY 10001, USA. Tel.: +1(212) 584-4662

Changes in Depressive Symptoms after Continuous Positive Airway Pressure Treatment for Obstructive Sleep Apnea

Melanie K. Means1 , Kenneth L. Lichstein2 , Jack D. Edinger1,3 , Daniel J. Taylor4 , H. Heith Durrence2 , Aatif M. Husain1,3 , R. Neal Aguillard5 , Rodney A. Radtke3
  • 1Department of Veterans Affairs Medical Center, Durham, North Carolina
  • 2The University of Memphis, Memphis, Tennessee
  • 3Duke University Medical Center, Durham, North Carolina
  • 4Brown Medical School, Providence, Rhode Island
  • 5Methodist University Hospital, Memphis, Tennessee
Further Information

Publication History

Publication Date:
24 April 2003 (online)

    Permissions and Reprints

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
    Google Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    PubMedGoogle Scholar
  • 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
    PubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    PubMedGoogle Scholar
  • 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
    PubMedGoogle Scholar
  • 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
    PubMedGoogle Scholar
  • 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
    PubMedGoogle Scholar
  • 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
    PubMedGoogle Scholar
  • 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
    PubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 16 Sink J, Bliwise D L, Dement W C. Self-reported excessive daytime somnolence and impaired respiration in sleep.  Chest . 1986;  90 177-180
    PubMedGoogle Scholar
  • 17 Gall R, Isaac L, Kryger M. Quality of life in mild obstructive sleep apnea.  Sleep . 1993;  16 S59-61
    PubMedGoogle Scholar
  • 18 Pillar G, Lavie P. Psychiatric symptoms in sleep apnea syndrome: effects of gender and respiratory disturbance index.  Chest . 1998;  114 697-703
    PubMedGoogle Scholar
  • 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
    PubMedGoogle Scholar
  • 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
    PubMedGoogle Scholar
  • 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
    PubMedGoogle Scholar
  • 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
    PubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    PubMedGoogle Scholar
  • 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
    PubMedGoogle Scholar
  • 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
    PubMedGoogle Scholar
  • 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
    PubMedGoogle Scholar
  • 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
    PubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    PubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 34 Wright J, White J. Continuous positive airways pressure for obstructive sleep apnea (Cochrane Review). In: The Cochrane Library, Issue 1, Oxford; Update Software
    Google Scholar
  • 35 Kaplan R. Obstructive sleep apnoea and depression-diagnostic and treatment implications.  Aust N Z J Psychiatry . 1992;  26 586-591
    PubMedGoogle Scholar
  • 36 Lee S. Depression in sleep apnea: a different view.  J Clin Psychiatry . 1990;  51 309-310
    PubMedGoogle Scholar
  • 37 Lee S, Wing Y K, Chen C N. Obstructive sleep apnoea and depression.  Aust N Z J Psychiatry . 1993;  27 162-166
    PubMedGoogle Scholar
  • 38 Cavanaugh S V. Diagnosing depression in the hospitalized patient with chronic medical illness.  J Clin Psychiatry . 1984;  45 13-17
    PubMedGoogle Scholar
  • 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
    PubMedGoogle Scholar
  • 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
    PubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    PubMedGoogle Scholar
  • 43 Beck A T, Rush A J, Shaw B F, Emery G. Cognitive Therapy of Depression. New York: Guilford Press; 1979
    Google Scholar
  • 44 Tanaka J S, Huba G J. Confirmatory hierarchical factor analyses of psychological distress measures.  J Pers Soc Psychol . 1984;  46 621-635
    CrossrefPubMedGoogle Scholar
  • 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
    PubMedGoogle Scholar
  • 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
    PubMedGoogle Scholar
  • 47 Barnes M, McEvoy R D, Pierce R J. Neurobehavioural impairment in mild sleep apnea patients compared to control subjects.  Sleep . 2001;  24 A276
    PubMedGoogle Scholar
  • 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
    PubMedGoogle Scholar
  • 49 Watson R, Greenberg G, Bakos L. Sleep apnea and depression.  Sleep Res . 1987;  16 293
    PubMedGoogle Scholar
  • 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
    Google Scholar
  • 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
    PubMedGoogle Scholar
  • 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
    Google Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    Google Scholar
  • 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
    PubMedGoogle Scholar
  • 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
    PubMedGoogle Scholar
  • 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
    PubMedGoogle Scholar
  • 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
    PubMedGoogle Scholar
  • 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
    PubMedGoogle Scholar
  • 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
    PubMedGoogle Scholar
  • 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
    PubMedGoogle Scholar
  • 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
    PubMedGoogle Scholar
  • 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
    PubMedGoogle Scholar
  • 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
    PubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
      >