Depressive Symptoms in Patients with Obstructive Sleep Apnea

A Narrative Review of Self-Reported Scales to Evaluate Depression and Anxiety Symptoms in Adult Obstructive Sleep Apnea Patients

Background and Objectives: Obstructive sleep apnea (OSA) is a prevalent chronic condition that has been associated with mental disorders like depression and anxiety. This study intends to provide a practical overview of the most relevant self-reported and self-rating scales that assess depression and anxiety in OSA patients. Materials and Methods: A search for articles was performed using PubMed, Google Scholar, and Semantic Scholar using a combination of words for obstructive sleep apnea, depression, anxiety, and scales. The tools were ordered by type (screening and rating) and arranged chronologically according to the year of publication. Results: Three scales were identified for assessing depression, which were the Center for Epidemiologic Studies Depression Scale (CES-D), the Hospital Anxiety and Depression Scale (HADS-D), and the Patient Health Questionnaire-9 (PHQ-9). For rating depression, two scales were discussed: the Zung Self-Rating Depression Scale (SDS) and the Beck Depression Inventory (BDI), which has three versions (the BDI, the BDI-II, and the Fast Screen (BDI-FS)). For assessing anxiety, the Generalized Anxiety Disorder-7 (GAD-7) scale was identified. Two scales were reviewed for rating anxiety: the State-Trait Anxiety Inventory (STAI) and the Beck Anxiety Inventory (BAI). Each scale is accompanied by a brief description of its practicality and psychometric qualities and an analysis of its strengths and limitations. Conclusions: The findings of this review will contribute to the understanding of the importance of assessing mental health comorbidities in the context of OSA, ultimately guiding clinical practice and future research in this area.

CPAP Therapy on Depressive and Anxiety Symptoms in Patients with Moderate to Severe Obstructive Sleep Apnea Syndrome

Backgrounds and Objectives: There is a link between sleep apnea syndrome (OSA) and depressive and anxiety symptoms, but the underlying mechanisms are not fully understood. The study aimed to determine the prevalence of these symptoms in patients with OSA and to evaluate the impact of continuous positive airway pressure (CPAP) on depression and anxiety scores. Materials and Methods: Ninety-nine consecutive new patients diagnosed with moderate or severe (apnea-hypopnea index AHI ≥ 15 events/h) OSA were accepted for the CPAP therapy. Patients completed a patient health questionnaire (PHQ-9) for depressive symptoms and a generalized anxiety questionnaire (GAD-7) for anxiety symptoms before the CPAP treatment, after 6 months, and after 1 year of CPAP therapy with compliance. For both scores (PHQ-9 and GAD-7), a cut point ≥10 was used to indicate the presence of clinically depressive and anxiety symptoms. Results: Forty-eight individuals (48.48%) had PHQ-9 scores above the cut-off point ≥ 10, and twenty-seven participants (27.27%) had GAD-7 scores above the cut-off point ≥10. A significant correlation has been shown between PHQ-9 score and BMI (p < 0.0001), AHI (p < 0.0001), ODI (p < 0.001), ESS (p < 0.001), GAD-7 score (p < 0.0001), and [t90] (p < 0.0001), while GAD-7 was correlated with AHI (p < 0.030), ODI (p < 0.006), and [t90] (p < 0.001). The PHQ-9 and GAD-7 scores decreased significantly after 6 months of CPAP therapy in all groups and after 1 year of CPAP use. Conclusions: OSA patients should be screened for depression and anxiety. Furthermore, CPAP should be the first choice of treatment before starting other treatments for depression and anxiety symptoms.

The Clinical Effects of the Phlegm-Resolving Method in the Treatment of Obstructive Sleep Apnea-Hypopnea Syndrome: A Meta-Analysis of Randomized Controlled Trials

Objective

This study evaluated the clinical efficacy and safety of the phlegm-resolving method in traditional Chinese medicine (TCM) for the treatment of obstructive sleep apnea-hypopnea syndrome (OSAHS).

Methods

We searched the PubMed, Embase, Cochrane Library, Wanfang, CNKI, and VIP databases according to specific search strategies. The data were analyzed using RevMan 5.3 software.

Results

Thirteen randomized controlled trials (RCTs) comprising 882 patients with OSAHS were selected. Compared to continuous positive airway pressure (CPAP), the phlegm-resolving method of TCM combined with CPAP significantly more effectively improved the apnea/hypopnea index (AHI), Epworth Sleepiness Scale (ESS), and lowest oxygen saturation (LSaO₂). While the treatment effect was better for a treatment duration of >6 weeks compared to that at ≤6 weeks, the difference was not statistically significant. Compared to health guidance alone, the combination of the phlegm-resolving method in TCM with health guidance showed significantly better efficacy in improving AHI, ESS, and LSaO₂. In terms of reducing ESS and increasing LSaO₂, the effect was better for treatment courses >6 weeks. When the AHI was reduced, a duration of ≤6 weeks showed more advantages; however, the difference was not significant. Only one study reported mild nausea in one participant in the treatment group at the initial stage of treatment; the remaining studies did not mention any side effects.

Conclusion

Both the resolving phlegm method of TCM combined with CPAP and the resolving phlegm method of TCM combined with health guidance were more effective in improving AHI, LSaO₂, and ESS compared to the control group.