Sleep apnoea and symptoms of depression and anxiety during pregnancy

Abstract

Oral Abstract Background: Symptoms of depression and anxiety have been shown to be more common in obstructive sleep apnea (OSA) patients than in the general population. Both the prevalence and severity of OSA increase during pregnancy. Pregnancy is also a time of high risk for the development of depression and anxiety. This study examined the association between OSA, sleep quality and symptoms of depression and anxiety in the third trimester of pregnancy. Methods: This observational study recruited pregnant women at greater than 26 weeks gestation with a single fetus presenting for antenatal care at King Edward Memorial Hospital, WA. Measurements included: sleep quality using the Pittsburgh Sleep Quality Index (PSQI); sleep disordered breathing using an ApneaLink monitor (nasal pressure and pulse oximeter); and symptoms of depression and anxiety from the Edinburgh Postnatal Depression Scale (EPDS). Data from medical records included age, parity, BMI, smoking status, history of depression and use of antidepressants. Results: Data from 126 women were analysed for presence of OSA (Apnea Hypopnea Index, AHI, ≥5). OSA was observed in 28 (22.2%) women. Symptoms of depression (defined as an EPDS score of ≥13) were observed in 11 (8.7%) women and symptoms of anxiety (measured as a score of ≥6 on questions 3, 4 and 5 of the EPDS) were observed in 16 (12.7%) women. Compared to women without depressive symptoms, those with depressive symptoms had higher AHI (p = 0.03). Women with symptoms of anxiety were more likely to have sleep apnoea (AHI≥5; p = 0.007). Multivariate analyses controlling for age, BMI, parity, smoking status and history of depression showed that: (i) depressive symptoms were related to AHI, ODI3%, ODI4% and antidepressant use (p < 0.001); and (ii) symptoms of anxiety were related to presence of sleep apnoea (AHI≥5) and antidepressant use (p < 0.001). Conclusion: OSA occurs in one fifth of women in late pregnancy. The severity of OSA is independently associated with symptoms of depression, while the presence of OSA is associated with symptoms of anxiety in pregnancy. The direction of this relationship is unknown but is an important focus for future research.