Abstract
PurposeThe objective was to assess the effect of continuous positive airway pressure (CPAP) on symptoms of anxiety and depression in patients with obstructive sleep apnea (OSA). We hypothesized a decrease in symptoms at follow-up, but that improvement relied on CPAP adherence.MethodsThe sample comprised 468 patients (mean age 55.5 years (SD = 12.0), 72% men) with OSA who received CPAP at a Norwegian hospital. OSA was diagnosed according to standard respiratory polygraphy. Mean baseline respiratory event index (REI) was 28.4 (SD = 20.6). Symptoms of anxiety and depression were assessed prior to CPAP treatment and at follow-up after a median of 20 weeks, range 6–52 weeks, with the Hospital Anxiety and Depression Scale (HADS). Patients were classified as CPAP adherent (≥ 4 h per night) or non-adherent (< 4 h per night).ResultsThere was a significant decrease in anxiety scores from baseline (mean = 5.16, SD = 3.94) to follow-up (mean = 4.76, SD = 3.81), p < 0.001. Similarly, depression scores decreased from baseline (mean = 4.31, SD = 3.66) to follow-up (mean = 3.89, SD = 3.69), p < 0.001. Cohen’s d (0.19 and 0.18, respectively) indicated small effect sizes. The reduction in anxiety scores did not depend on CPAP adherence (no interaction effect F(1, 466) = 0.422, p = 0.516), whereas the reduction in depression scores were seen only in the CPAP adherent group (interaction effect F(1, 466) = 7.738, p = 0.006).ConclusionsWe found a decrease in symptoms of anxiety and depression from baseline to follow-up of CPAP treatment. The improvement in symptoms of depression was depending on CPAP adherence. This underlines the importance of adherence for optimal effect of CPAP treatment.
Highlights
Obstructive sleep apnea (OSA) is a common sleep disorder characterized by breathing pauses during sleep [1]
We found a decrease in symptoms of anxiety and depression from baseline to follow-up of continuous positive airway pressure (CPAP) treatment
We found a significant decrease in symptoms of anxiety and depression at follow-up compared to baseline
Summary
Obstructive sleep apnea (OSA) is a common sleep disorder characterized by breathing pauses during sleep [1]. OSA is associated with increased levels of psychiatric comorbidities, such as anxiety and depression [1, 6]. Anxiety and depression are widespread public health challenges and are together with substance use disorders leading causes of years lived with disability worldwide [7]. In a review including 55 publications from 1995 to 2006 looking at anxiety and depression in OSA patients, the prevalence of anxiety varied from 11 to 70% and the prevalence of depression varied from 7 to 63% [6]. The large range in prevalence was related to many factors, including the use of different mood scales. The review addressed several limitations of the included studies, such as low number of participants, validity issues with the mood scales, and different methods for diagnosing OSA
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