Depression as a Manifestation of Obstructive Sleep Apnea

Association between obstructive sleep apnea severity and depression risk: a systematic review and dose-response meta-analysis

Obstructive sleep apnea (OSA) has received considerable attention as a potential risk factor for depressive symptoms. The systematic review was conducted to confirm the dose‒response connection between OSA severity and depression risk. A systematic literature search of English and Chinese articles published in PubMed, EMBASE, Scopus, Web of Science, Cochrane Library, China National Knowledge Infrastructure (CNKI), and SinoMed databases from their inception to 28 August 2023 was conducted. An evaluation using the Newcastle‒Ottawa Scale was performed. A meta-analysis was used to evaluate the impact of OSA severity. A random-effects dose‒response model was conducted to evaluate the linear and nonlinear dose‒response connections. We evaluated publication bias by funnel plots, and symmetry by Egger's test. We identified 18 cross-sectional researches. 3143 participants which were involved in the dose‒response meta-analysis. Contrasted with mild OSA, individuals with severe OSA had a higher adjusted risk of depression (rate ratio: 1.34, 95% confidence interval = 1.05-1.70), with substantial heterogeneity (I2 = 70.9%, Pheterogeneity<0.001). There is a significant linear connection between OSA severity and depression risk. The depression risk increased by 0.4% for every 1 event per hour increase in the apnea-hypopnea index (AHI). The protocol for this unfunded research was drafted and registered at PROSPERO (ID CRD42023474097).

An exploratory study on the association between serotonin and sleep breathing disorders

This exploratory observational study aimed to evaluate whether the blood levels of serotonin and enzymes involved in serotonin synthesis are associated with sleep breathing parameters. A total of 105 patients were included in this study, who were subjected to single-night polysomnography with simultaneous audio-video recordings. Peripheral blood samples were collected to estimate the serum levels of serotonin, tryptophan hydroxylase 1 (TPH1), and aromatic l-amino acid decarboxylase (AADC). Results showed a negative correlation between blood serotonin levels, and oxygen desaturation index (ODI) (p = 0.027), central apnea (p = 0.044) and obstructive apnea (OA) (p = 0.032) scores. Blood TPH1 levels were negatively correlated with average (p = 0.003) and minimal saturation (p = 0.035) and positively correlated with apnea-hypopnea index (p = 0.010), OA (p = 0.049), and hypopnea index (p = 0.007) scores. A tendency to sleep-disordered breathing seemed to co-occur with lower blood serotonin and higher TPH1 levels.Clinical Trial Registration : www.ClinicalTrials.gov , identifier NCT04214561.

The Burden of Comorbidities in Obstructive Sleep Apnea and the Pathophysiologic Mechanisms and Effects of CPAP

Micro-arousals and the repeated desaturation of oxyhemoglobin, which are typical in obstructive sleep apnea syndrome (OSAS), have adverse effects on the health of patients, leading to a wide range of complications such as cardiovascular (arterial hypertension, pulmonary hypertension, chronic heart failure, arrhythmias, myocardial infarction), cerebrovascular (strokes), metabolic (insulin resistance, obesity, diabetes mellitus, metabolic syndrome), gastrointestinal (non-alcoholic liver disease), urinary (chronic renal failure), and neuropsychiatric complications as well as a wide range of malignancies. These, in turn, have multilateral effects on familial, occupational, and social life, as well as increasing the risks of road traffic accidents and accidents at the workplace. Awareness, timely screening, and the prevention of complications play important roles in diagnosing and treating comorbid conditions. This review focuses on comorbidities in OSAS and the effect of Continuous Positive Airway Pressure (CPAP) therapy on their prognoses.

Sleep disturbances and their correlation with cardiovascular risk, obesity, and mood disorders in people with HIV

BACKGROUND

The relationship between sleep disorders (SDs), cardiovascular risk (CVR), and mood disorders (MDs) has been studied in detail in the general population, but far less in people with HIV (PWH).

METHODS

Cross-sectional analysis in single centre cohort of PWH. Sleep quality was assessed using by Epworth Sleepiness Scale (ESS), Insomnia Severity Index (ISI), Berlin Questionnaire (BQ), Pittsburgh Sleep Quality Index (PSQI); anxiety and depression were evaluated by the Generalized Anxiety Disorder-7 and Patient Health Questionnaire-9. Demographic, clinical and HIV-related data were collected, and Framingham and Data collection on Adverse effects of anti-HIV Drugs (DAD)-10 scores were computed in modelling associations with each SDs scale.

RESULTS

Data were collected for 721 PWH on stable combination antiretroviral therapy (cART) (median age of 53 years, 71.8% males, 96% with undetectable HIV RNA, 50.3% on cART potentially affecting sleep, and 20.4% on hypno-inducing drugs), 76.9% had SDs 60.3, 31.3, 31.1, and 7.9% at PSQI, BQ, ISI, and ESS, respectively. Anxiety and depression were detected in 28.3 and 16.1% participants, respectively. BQ score was independently associated with high BMI ( P  < 0.001), Framingham risk >10% ( P  < 0.001), and both DAD-10R and -10F score >10% ( P  < 0.001 and P  = 0.031). PSQI and ISI scores were independently associated with depression and anxiety ( P  < 0.001). No association between SDs and specific antiretroviral regimens, nor HIV-related parameters was detected.

CONCLUSIONS

In our cohort of PWH on stable ART, despite the alarmingly higher prevalence, SDs were associated with the same determinants (cardiovascular risk factors and MDs) observed in the general population.

Association of sleep apnea and depressive symptoms among US adults: a cross-sectional study

BACKGROUND

Sleep apnea exerts adverse health effects due to inflammation and metabolic disruption. It is associated with metabolic diseases. However, the evidence of its relationship with depression is inconsistent. Therefore, this study aimed to investigate the relationship between sleep apnea and depressive symptoms in adults in the United States.

METHODS

This study utilized data from the National Health and Nutrition Examination Survey (NHANES), wherein the data from 2005 to 2018 of 9,817 individuals were obtained. Sleep apnea was self-reported by the participants using a questionnaire on sleep disorders. The 9-item Patient Health Questionnaire (PHQ-9) was used to assess depressive symptoms. We implemented multivariable logistic regression and stratified analyses to assess the correlation between sleep apnea and depressive symptoms.

RESULTS

A total of 515 (6.6%) participants among 7,853 non-sleep apnea participants and 269 (13.7%) subjects among 1,964 sleep apnea participants had a depression score ≥ 10, they were deemed to have depressive symptoms. The multivariable regression model, showed that individuals with sleep apnea were 1.36-fold more likely to experience depressive symptoms when adjusted for potential covariates (odds ratios [OR] with 95% confidence intervals of 2.36 [1.71-3.25]), and a positive correlation between depressive symptoms and sleep apnea severity was found. The stratified analyses, revealed that sleep apnea was related to an increased incidence of depressive symptoms in most subgroups, except for those with coronary heart disease. Further, there was no interaction between sleep apnea and the covariates.

CONCLUSIONS

Adults with sleep apnea in the US have a relatively high prevalence of depressive symptoms. and the severity of sleep apnea positively correlated with the depressive symptoms.

Alzheimer's Disease Biomarkers and Complement Proteins Mediate the Impact of Sleep Fragmentation on Cognitive Impairment in Obstructive Sleep Apnea Patients Without Dementia

BACKGROUND

Cognitive impairment is common in patients with obstructive sleep apnea (OSA). Previous studies indicated that intermittent hypoxia, sleep fragmentation, and depressive symptoms were associated with cognitive impairment in OSA patients.

OBJECTIVE

The study aimed to investigate whether sleep characteristics and depressive symptoms affected cognitive abilities mediated by Alzheimer's disease (AD) biomarkers and complement proteins in OSA patients without dementia.

METHODS

A total of 317 subjects without dementia who had undergone polysomnography, cognitive and neuropsychological evaluations, were recruited. Neuronal-derived exosomes (NDEs) levels for amyloid-β (Aβ), total tau (T-tau), and tau phosphorylated 62 at threonine 181 (P-T181-tau) and astrocyte-derived exosomes (ADEs) levels for complement proteins were measured. Mediation analysis were performed to explore the mediation effects of AD biomarkers (Aβ42, T-tau, P-T181-tau) and complement proteins (C3b and C5b-9) on cognition.

RESULTS

The findings revealed that the association between sleep fragmentation and cognition was mediated by Aβ42 (the percentage varied from 18.25% to 30.6%), P-T181-tau (the percentage varied from 24.36% to 32.3%), and C5b-9 (the percentage varied from 30.88% to 60.7%). The influence of depressive symptoms on cognition was only mediated via C3b (the percentage varied from 24.1% to 36.6%).

CONCLUSIONS

In OSA patients without dementia, Aβ42 and P-T181-tau levels in NDEs, and C5b-9 levels in ADEs mediated the impact of sleep fragmentation on cognitive impairment, and C3b levels in ADEs mediated the impact of depressive symptoms on cognitive impairment.

Prevalence of mental illness in patients with obstructive sleep apnea – A cross-sectional study from Kashmir, India

Aim

The study aimed to evaluate the prevalence of mental illness in obstructive sleep apnea (OSA) and to examine whether patients with obstructive sleep apnea require screening for mental illness.

Methods

We performed polysomnography studies of patients that were referred from various subspecialty clinics in Kashmir from Jan 2020–December 2020. using the Mini-International Neuropsychiatric Interview (MINI plus) scale to make a psychiatric diagnosis. We administered the General Health Questionnaire – 28 (GHQ – 28), Hamilton Depression Rating Scale (HAM-D), and Hamilton Anxiety Rating Scale (HAM-A) to patients. Descriptive statistics and correlations were used for data analysis.

Results

182 patients underwent polysomnography, 85 (46.7%) of which were suffering from mental illness Based on the Apnea-Hypopnea Index score, 8 (4.39%) patients had mild, 35 (41.1%) had moderate and 42 (49.4%) had severe OSA. The mean GHQ -28 score was significantly higher in patients with Obstructive sleep apnea (p < 0.001) (11.34 ± 8.2) as compared to non-Obstructive sleep apnea patients (1.98 ± 4.38).

Conclusions

This study demonstrates the increased prevalence of anxiety and depression in patients with OSA. Therefore, we recommend timely screening for any mental health issues in patients with OSA and necessary interventions to address the issues, thus preventing mental health morbidities in patients with OSA this would help subsequently in an improved lifestyle.

•

This study highlighted the prevalence of mental illness in obstructive sleep apnea (OSA).

•

Almost one-half of the patients diagnosed with OSA had mental illness.

•

Appropriate measures should be undertaken to control prevalence of anxiety and depression in patients with OSA.

Prevalence of depression and anxiety in obstructive sleep apnea

INTRODUCTION

Organic comorbidities of obstructive sleep apnea (OSA) have been widely studied. However, psychiatric disorders, especially depression and anxiety, have not attracted so much attention.

AIM

The primary aim was to determine the prevalence and the predictive factors of depression and anxiety in OSA patients. The secondary aim was to investigate the association between OSA severity and these psychiatric disorders.

METHODS

A cross-sectional study including untreated OSA patients without mental illness history was conducted. Patients were administered the Hospital Anxiety (HADS-A) and Depression Scale (HADS-D). Depression and anxiety were diagnosed for HAD-D and HAD-A scores ≥ 8.

RESULTS

Eighty patients were included (mean age: 54.83 ± 13.12 yr; female: 52 (65%); mean Body mass index (BMI) :34.7±6.14 kg/m2). The prevalence of depression and anxiety was 35 % and 43.8% of patients respectively. Both depressive and anxious OSA patients had more libido disorder ( p=0.011, p=0.0007 ;respectively), anhedonia (p= 10-4, p= 10-4respectively ) and suicidal ideas(p= 0.002 ,p=0.019 respectively). Moreover, depressed OSA patients had lower socio-economic condition (p= 0.019), more coronary artery diseases (CAD) (p=0.019) and less cognitive disorder (p= 0.005). The HADS-D (r=0,095; p=0,404) and the HADS-A (r=0,212; p=0,059) were not correlated with the Apnea/Hyponea Index. The determinants of depressive and anxious mood were female-sex (p= 0.035, p=0.004 respectively) and libido disorder (p=0.040, p=0.02 respectively). Anhedonia (p=10-4) and CAD (p=0.010) were also identified as a predictive factors of depression.

CONCLUSIONS

In our study, the high prevalence of depression and axiety in apneic patients demonstrates the importance of the psychiatric component in the management of this disease. A collaboration between pneumologists and psychiatrists is necessary in order to improve the quality of life of these patients.

Post-Operative Patients’ Satisfaction and Quality of Life Assessment in Adult Patients with Obstructive Sleep Apnea Syndrome (OSAS)

Background: The treatment for severe OSAS includes maxillomandibular advancement surgical option in selected cases. The aim of this study was to evaluate the post-operative impact of bimaxillary surgery on satisfaction and consequently the quality of life of these patients. Methods: This study included 18 patients with severe OSAS who received maxillomandibular advancement surgery. Patients were divided into Group A (operated by CAD/CAM) and Group B (conventional surgery). The impact of bimaxillary surgery on satisfaction and quality of life of these patients was evaluated by utilizing post-operative life quality and Rustemeyer’s patient-satisfaction-based survey. Results: A total of 18 adult OSAS patients (Group A: 11 patients, Group B: 7 patients) with a mean age of 44.39 years (SD ± 9.43) were included. Mean follow-up period was 32.64 months (SD ± 21.91). No intra-operative complications were seen in any patients. Post-operative complication was seen in one patient and the mandible did not integrate. According to the results, overall post-operative satisfaction score was 79.72% (SD ± 9.96). There was no significant difference among those in Group A and Group B. Conclusion: Maxillomandibular advancement surgery seems to be beneficial in terms of patients’ satisfaction in severe adult OSAS patients and can be considered as a valuable option in selected cases.

Poor sleep Quality and Obstructive Sleep Apnea are Associated with Maternal Mood, and Anxiety Disorders in Pregnancy

BACKGROUND

Previous studies suggest sleep quality and obstructive sleep apnea (OSA) may be associated with psychiatric symptoms, including depression, anxiety, and posttraumatic stress disorder (PTSD). However, few studies have examined the relationship between sleep quality and OSA with maternal psychiatric symptoms during pregnancy, a state of vulnerability to these disorders.

OBJECTIVE

The objective of our study is to examine the association between poor sleep quality and sleep apnea with antepartum depression, anxiety, and PTSD among pregnant women.

METHODS

A cross-sectional study was conducted among women seeking prenatal care in Lima, Peru. Sleep quality was measured using the Pittsburgh Sleep Quality Index, and the Berlin questionnaire was used to identify women at high risk for OSA. Depression, generalized anxiety, and PTSD symptoms were measured using the Patient Health Questionnaire-9, Generalized Anxiety Disorder Assessment, and PTSD Checklist - Civilian Version. Multivariate logistic regression procedures were used to estimate adjusted odds ratios (aOR) and 95% confidence intervals (95% CI).

RESULTS

Approximately 29.0X% of women had poor sleep quality, and 6.2% were at high risk for OSA. The prevalence of psychiatric symptoms was high in this cohort with 25.1%, 32.5%, and 30.9% of women reporting symptoms of antepartum depression, antepartum anxiety, and PTSD, respectively. Women with poor sleep quality had higher odds of antepartum depression (aOR = 3.28; 95%CI: 2.64-4.07), generalized anxiety (aOR = 1.94; 95%CI: 1.58-2.38), and PTSD symptoms (aOR = 2.81; 95% CI: 2.28-3.46) as compared with women who reported good sleep quality. Women with a high risk of OSA had higher odds of antepartum depression (aOR = 2.36; 95% CI: 1.57-3.56), generalized anxiety (aOR = 2.02, 95% CI: 1.36-3.00), and PTSD symptoms (aOR = 2.14; 95%CI: 1.43-3.21) as compared with those with a low risk of sleep apnea.

CONCLUSIONS

Poor sleep quality and high risk of OSA are associated with antepartum depression, generalized anxiety, and PTSD symptoms among pregnant women. Further characterizations of the associations of these prevalent sleep, mood, and anxiety conditions among pregnant women could aid in evaluating and delivering optimal perinatal care to women with these comorbidities.

Self-reported sleep and exercise patterns in patients admitted with suicidal attempts: a cross-sectional comparative study

BACKGROUND

There is evidence that sleep disturbances and exercise are risk factors for suicide attempts; however, whether sleep disturbances are independently associated with suicide attempts is debatable. We compared the sleep and exercise patterns of individuals who attempted suicide to those of the general population and investigated whether sleep disturbances were independently associated with suicide attempts.

METHODS

Over a year, individuals presented to the emergency department at Hamad General Hospital and Mental Health Services in Doha with suicide attempts (n = 127) filled out questionnaires on sleep and exercise, demographics, and clinical measures. A control group (n = 126) from two primary care centers filled out the same questionnaires during the same period.

RESULTS

Subjects in the suicide group were significantly younger, single, had a lower level of education, and showed considerably more early insomnia, daytime tiredness, interrupted sleep, and no regular exercise. The most common diagnoses seen with suicidality were adjustment disorder and major depression, and the most common method used to attempt suicide was an overdose. After multiple regression analysis, being Arab, belonging to the category "other nationalities," unemployment, and early insomnia were significantly associated with an increased risk of suicide attempts.

CONCLUSION

This is the first comparative study on suicide in the Arabian Gulf. Individuals in Qatar with acute stress, depressive symptoms, sleep disturbances, and lack of exercise are at increased risk of attempting suicide. Thus, clinicians need to routinely screen for sleep and physical activity because of their significant contribution to physical and mental well-being.

Obstructive Sleep Apnoea Severity Is Negatively Associated with Depressive Symptoms: A Cross-Sectional Survey of Outpatients with Suspected Obstructive Sleep Apnoea in Japan

Background: Multiple clinical departments are involved in the provision of obstructive sleep apnoea (OSA) therapy in Japan. Inconsistent results regarding the association between depression and OSA have been reported. Methods: This cross-sectional survey compared newly diagnosed OSA patients at two outpatient sleep apnoea units in Shiga Prefecture, Japan: one associated with the psychiatry department (n = 583), and the other with the otolaryngology department (n = 450). Results: The unit associated with the psychiatry department had more patients referred by psychiatrists than that with the otolaryngology department (11% vs. 3% p < 0.05). Sleepiness, insomnia, and depression were assessed using the Epworth Sleepiness Scale (ESS), Athens Insomnia Scale (AIS), and Patient Health Questionnaire-9 (PHQ-9), respectively. The ESS, AIS, and PHQ-9 scores were higher in the sleep unit in the psychiatry department (p < 0.001 each). Snoring and moderate to severe OSA were more prevalent in the unit attached to the otolaryngology department (p < 0.001 each). Patients with moderate to severe OSA had lower PHQ-9 scores than those with no to mild OSA (OR: 0.96, 95% CI: 0.92−1.00, p = 0.042). Conclusion: Patients with sleepiness, insomnia, and depressive symptoms were more likely to attend a sleep outpatient unit associated with a psychiatry department, whereas those with snoring and sleep apnoea attended that associated with an otolaryngology department. OSA severity was negatively associated with depressive symptoms.

Neuropsychological and socio-cognitive deficits in patients with obstructive sleep apnea

Introduction: Patients with obstructive sleep apnea (OSA) suffer from several neurocognitive deficits. We investigated the cognitive and socio-cognitive profiles of patients with severe OSA, controlling for potentially relevant mediating variables (i.e. age, body-mass index, cognitive reserve and depression). Moreover, we studied the neuropsychological profile of a high-risk OSA phenotype characterized by severe OSA and severe nocturnal hypoxemia.Method: We assessed 29 previously untreated severe OSA patients with a mean age of 55.6 (± 9.9 years) and a mean apnea-hypopnea index (AHI) of 53.1 (± 17.4). A control group of 34 healthy participants was also enrolled. Participants completed an extensive neuropsychological battery that included social cognition, a relatively new investigation area among OSA patients.Data analysis: Data were analyzed with a Bayesian approach. Specifically, Bayesian ANCOVA was used to investigate whether the grouping variable could predict test performance. Age, body-mass index, cognitive reserve and state of depression were added as covariates to the null model to weight the effects of these potential confounding factors. Three groups were analyzed: healthy controls (H), OSA with severe apnea and severe nocturnal oxygen desaturation (D⁺), and OSA with severe apnea non-desaturators (D^-). Performances on the various neuropsychological tests were treated as the dependent variables.Results: The results indicate that non-verbal reasoning, the theory of mind skills, and mental shifting ability were impaired in OSA patients. Patients with severe nocturnal hypoxemia underperformed compared to patients with the same severity of apnea but non-desaturators. Additionally, we observed a trend toward a worse performance among OSA desaturator patients in the following abilities: constructional ability, short term verbal memory, phonological fluency, and the ability to inhibit automatic and dominant responses.Conclusion: The data suggest a key role of hypoxemia in affecting cognitive functioning in OSA patients. Executive functions and the concomitant involvement of social cognition are particularly affected.

Differential associations of hypoxia, sleep fragmentation, and depressive symptoms with cognitive dysfunction in obstructive sleep apnea

Obstructive sleep apnea (OSA) is characterized by recurrent episodes of partial or complete cessation of breathing during sleep and increased effort to breathe. This study examined patients who underwent overnight polysomnographic studies in a major sleep laboratory in Saudi Arabia. The study aimed to determine the extent to which intermittent hypoxia, sleep disruption, and depressive symptoms are independently associated with cognitive impairments in OSA. In the sample of 90 participants, 14 had no OSA, 30 mild OSA, 23 moderate OSA, and 23 severe OSA. The findings revealed that hypoxia and sleep fragmentation are independently associated with impairments of sustained attention and reaction time (RT). Sleep fragmentation, but not hypoxia, was independently associated with impairments in visuospatial deficits. Depressive symptoms were independently associated with impairments in the domains of sustained attention, RT, visuospatial ability, and semantic and episodic autobiographical memories. Since the depressive symptoms are independent of hypoxia and sleep fragmentation, effective reversal of cognitive impairment in OSA may require treatment interventions that target each of these factors.

Obstructive sleep apnea and depression: A systematic review and meta-analysis

INTRODUCTION

The present study aimed to review the association between obstructive sleep apnea (OSA) and depression and compare the prevalence of depression among people with and without OSA.

METHODS

Systematic review and meta-analysis following PRISMA guidelines. We searched for papers published between 1 January 2010 and 20 October 2019 listed on the following databases: Embase, Ovid MEDLINER(R) and PsychINFO. The search terms included a combination of keywords related to sleep apnea and depression. We also completed a manual search of the references listed in the articles retrieved and grouped them according to study design: cross-sectional, case-control and longitudinal. Scale scores were standardised for comparison.

RESULTS

Our search strategy yielded 1158 papers, of which 34 were considered suitable of review and 11 reported data that could be used for meta-analysis. Data from the 6 cross-sectional studies found no compelling evidence of an association between OSA and depression (odds ratio = 1.12, 95 % confidence interval, 95 %CI = 0.78, 1.47), but the meta-analysis of 5 longitudinal studies indicated that people with OSA were at greater risk of developing depression during follow-up than those without OSA (non-specific risk ratio (RR) = 2.18, 95 %CI = 1.47, 2.88), although there was evidence of high study heterogeneity (I² = 72.8 %).

DISCUSSION

The results of this systematic review and meta-analysis of observational studies is consistent with the hypothesis that OSA may increase the risk of depression. Sample characteristics and various methodological issues create uncertainty about the validity and generalizability of these associations.

An exploration of adult attachment insecurity and psychiatric symptoms in individuals with obstructive sleep apnea

OBJECTIVE

Obstructive sleep apnea (OSA) is a common sleep disorder, often associated with multiple medical comorbidities as well as psychological difficulties. Among the latter, relationship difficulties as well as mood and anxiety symptoms have been reported, without a clear understanding of the mechanism. In the current study we wanted to further explore these aspects, while comparing groups of OSA individuals with good vs poor sleep. The primary goal of the study was to examine the relationship between sleep and adult attachment and secondly to explore the relationship between sleep and couple satisfaction as well as symptoms of depression and anxiety.

METHODS

Following diagnosis of OSA by overnight polysomnography, 102 participants completed several psychological measures (e.g. adult attachment, couple satisfaction, depression and anxiety symptoms) and sleep measures (sleep quality and daytime sleepiness). Variables of interest were compared between the OSA groups with either good/poor sleep quality or no/excessive daytime sleepiness.

RESULTS

Adult attachment avoidance was higher in individuals with low sleep quality (mean difference = 0.33, p = .04, d = 0.46) while adult attachment anxiety was higher in individuals with high daytime sleepiness (mean difference = 0.46, p = .04, d = 0.43). Individuals with either poor sleep quality or excessive daytime sleepiness had greater severity of depression and anxiety (both p < .05).

CONCLUSIONS

OSA patients with poor sleep quality and excessive daytime sleepiness have greater attachment insecurity and higher levels of depression and anxiety. A multidisciplinary approach including psychological interventions, should be considered in OSA cases with high levels of sleep disturbance.

Is Maxillomandibular Advancement Associated With Comorbidity Reduction in Patients With Obstructive Sleep Apnea?

PURPOSE

This study investigated whether patients with documented obstructive sleep apnea (OSA) who have a decrease in apnea-hypopnea index (AHI) score and self-reported symptoms after maxillomandibular advancement (MMA) with genial tubercle advancement (GTA) also have a change in their medical comorbidity profile a minimum of 2 years postoperatively. Changes in the quantity of medical diagnoses, quantity of prescription medications, and average weight and body mass index (BMI) were assessed.

PATIENTS AND METHODS

This is a retrospective cohort study of patients with a diagnosis of OSA (AHI score >5 on polysomnogram [PSG]) treated at the Massachusetts General Hospital (Boston, MA) with MMA and GTA from 2001 through 2015. Patients were identified through the oral and maxillofacial surgery patient data registry. Inclusion criteria were the availability of complete clinical records and requisite follow-up time. The primary predictor variable was operative status (preoperative or postoperative). The primary outcome variables were comorbidities reported to be associated with OSA and identified in the authors' previous study (J Oral Maxillofac Surg 76:1999.e1, 2018). Two-tailed paired t tests were used for continuous variables and χ² or Fisher exact tests were used for categorical variables.

RESULTS

Forty-six patients (39 men, 7 women) met the inclusion criteria. Average weight (206.7 ± 42.4 lb preoperatively; 213.8 ± 41.7 lb postoperatively; P = .014) and average BMI (30.0 ± 5.7 kg/m² preoperatively; 30.9 ± 5.3 kg/m² postoperatively; P = .041) significantly increased in patients postoperatively. No meaningful changes in the number of medical diagnoses or number of prescription medications were noted. Stratification of patients by BMI showed significant increases in weight (188.6 ± 21.5 lb preoperatively; 200.1 ± 27.9 lb postoperatively; P = .0085) and BMI (27.1 ± 1.44 kg/m² preoperatively; 28.9 ± 3.52 kg/m² postoperatively; P = .013) only in "overweight" patients. No other parameters were found to be relevant.

CONCLUSIONS

Subjective improvement in OSA symptoms was reported by all patients and objective PSG improvement was reported for 71% of those evaluated. However, no relevant changes in comorbidity profile were found, suggesting that the medical conditions commonly observed with OSA are likely of multifocal etiology.

Does the Medical Comorbidity Profile of Obstructive Sleep Apnea Patients Treated With Maxillomandibular Advancement Differ From That of Obstructive Sleep Apnea Patients Managed Nonsurgically?

PURPOSE

Obstructive sleep apnea (OSA) patients with retrognathia and measurable anatomic airway determinants may represent a subset of OSA patients and have distinct comorbidity profiles. Our aim was to compare the medical comorbidities of OSA patients managed surgically with maxillomandibular advancement with those of nonsurgical patients.

PATIENTS AND METHODS

In this cross-sectional retrospective study, patients for both cohorts were identified through the Massachusetts General Hospital oral and maxillofacial surgery data registry and the Massachusetts General Hospital Research Patient Data Registry. The inclusion criteria consisted of clinical records documenting body mass index (BMI), apnea-hypopnea index, respiratory disturbance index, and/or oxygen nadir. The primary predictor variable was the treatment modality chosen: surgical (maxillomandibular advancement) or nonsurgical. Demographic information and OSA parameters were evaluated. The primary outcome variable was the number of documented comorbidities in each group. Two-sample t tests were used for continuous variables, whereas χ² or Fisher exact tests were used for categorical variables.

RESULTS

The nonsurgical cohort consisted of 71 patients (67.6% men), and the surgical cohort consisted of 51 patients (84.3% men). Comparison of descriptive characteristics showed that the nonsurgical cohort had a higher average age (49 ± 9.4 years) than the surgical cohort (41 ± 10.7 years, P < .001). In addition, a higher average BMI was present in the nonsurgical group (42.3 ± 11.9 in nonsurgical group vs 29.7 ± 5.5 in surgical group, P < .001). Polysomnogram parameters were comparable with the exception of a higher Epworth Sleepiness Scale score in the surgical cohort (15.5 ± 5.30 in surgical group vs 9.90 ± 6.80 in nonsurgical group, P = .005). The nonsurgical cohort had a higher total number of comorbidities (7 ± 4 in nonsurgical group vs 4 ± 3 in surgical group, P < .001). Hypertension, cardiovascular disease, hyperlipidemia, pulmonary hypertension, obstructive pulmonary disease, and type 2 diabetes mellitus had higher prevalences within the nonsurgical group.

CONCLUSIONS

The results of this study suggest that nonsurgically managed OSA patients tend to have more complex medical comorbidity profiles than those managed surgically. Obesity (BMI >30) was more prevalent in the nonsurgical cohort, which may be contributory. The additive contribution of OSA needs to be further elucidated.