The relationship between anxiety, depression, daytime sleepiness in the REM-related mild OSAS and the NREM-related mild OSAS
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Obstructive sleep apnea syndrome (OSAS) is a common form of sleep-related respiratory disease characterized by recurrent blockages in the upper airway. Rapid eye movement (REM)-related OSAS is a condition in which apneas and hypopneas are more common during REM sleep. We investigated whether there was any difference between REM-related mild OSAS group and NREM-related mild OSAS group in terms of anxiety, depression, and daytime sleepiness.
A total of 166 patients with mild OSAS (72 patients with REM-related and 94 NREM-related OSAS) participated in the study. Hospital Anxiety-Depression Scale (HADS) and Epworth Sleepiness Scale (ESS) questionnaires were completed by both groups.
Anxiety and depression scores were significantly higher in patients with REM-related OSAS in comparison to the NREM-related OSAS group (p = 0.01, p = 0.02 respectively). There was no statistically significant difference between the two groups in terms of ESS scores (p = 0.60).
The results of our study suggest that patients with REM-related OSAS have higher rates of depression and anxiety compared to non-REM-related OSAS patients and this may adversely affect quality of life. It may be possible to prevent psychiatric complications, such as depression and anxiety, by administering treatments that reduce REM sleep duration and intensity in patients with REM-related OSAS.
KeywordsObstructive sleep apnea REM-related OSAS Hospital Anxiety-Depression Scale Epworth Sleepiness Scale Depression Low arousal threshold
Compliance with ethical standards
Conflict of interest
The authors declare that they have no conflict of interest.
This article does not contain any studies with animals performed by any of the authors. All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. The institutional review board (IRB) approved the research methodology.
Informed consent was obtained from all individual participants included in the study.
- 5.Berry RB, Budhiraja R, Gottlieb DJ, Gozal D, Iber C, Kapur VK, Marcus CL, Mehra R, Parthasarathy S, Quan SF, Redline S, Strohl KP, Davidson Ward SL, Tangredi MM (2012) Rules for scoring respiratory events in sleep: update of the 2007 AASM manual for the scoring of sleep and associated events. Deliberations of the sleep apnea definitions task force of the American Academy of Sleep Medicine. J Clin Sleep Med 8(5):597–619Google Scholar
- 6.Thombs BD, Benedetti A, Kloda LA, Levis B, Azar M, Riehm KE, Saadat N, Cuijpers P, Gilbody S, Ioannidis JP, McMillan D, Patten SB, Shrier I, Steele RJ, Ziegelstein RC, Loiselle CG, Henry M, Ismail Z, Mitchell N, Tonelli M (2016) Diagnostic accuracy of the Depression subscale of the Hospital Anxiety and Depression Scale (HADS-D) for detecting major depression: protocol for a systematic review and individual patient data meta-analyses. BMJ Open 6(4):e011913CrossRefGoogle Scholar
- 10.Oksenberg A, Arons E, Nasser K, Vander T, Radwan H (2010) REM related obstructive sleep apnea: the effect of body position. J Clin Sleep Med 6:343–348Google Scholar
- 14.Gupta MA, Simpson FC (2015) Obstructive sleep apnea and psychiatric disorders: a systematic review. J Clin Sleep Med 11(2):165–175Google Scholar
- 18.Staner L, Kerkhofs M, Detroux D, Leyman S, Linkowski P, Mendlewicz J (1995) Acute, subchronic and withdrawal sleep EEG changes during treatment with paroxetine and amitriptyline: a double-blind randomized trial in major depression. Sleep 18(6):470–477Google Scholar
- 19.Kraiczi H, Hedner J, Dahlöf P, Ejnell H, Carlson J (1999) Effect of serotonin uptake inhibition on breathing during sleep and daytime symptoms in obstructive sleep apnea. Sleep 22(1):61–67Google Scholar
- 22.Luthringer R, Toussaint M, Schaltenbrand N et al (1996) A double-blind, placebo-controlled evaluation of the effects of orally administered venlafaxine on sleep in inpatients with major depression. Psychopharmacol Bull 32:637–646Google Scholar
- 23.Thase ME (1998) Depression, sleep, and antidepressants. J Clin Psychiatry 59(Suppl 4):55–65Google Scholar
- 27.İtil O (2016) Uykuda kardiak kayıtlama ve skorlama. J Turk Sleep Med 3(1):29–29Google Scholar
- 28.Al Oweidat K, AlRyalat SA, Al-Essa M, Obeidat N (2018) Comparing REM- and NREM-related obstructive sleep apnea in Jordan: a cross-sectional study. Can Respir J 12:9270329Google Scholar
- 29.Zinchuk A, Edwards BA, Jeon S, Koo BB, Concato J, Sands S, Wellman A, Yaggi HK (2018) Prevalence, associated clinical features, and impact on continuous positive airway pressure use of a low respiratory arousal threshold among male United States veterans with obstructive sleep apnea. J Clin Sleep Med 14(5):809–817CrossRefGoogle Scholar