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Anxiety and depression in patients with chronic obstructive pulmonary disease and obstructive sleep apnea: the overlap syndrome

  • Sleep Breathing Physiology and Disorders • Original Article
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Abstract

Purpose

Psychological symptoms are increasingly being noted in patients with chronic diseases. Currently, little evidence is available on the mental health of patients with overlap syndrome (OVS, chronic obstructive pulmonary disease plus obstructive sleep apnea). This study aimed to describe the prevalence and identify influencing factors of anxiety and depression in patients with OVS.

Methods

We recruited patients admitted for chronic obstructive pulmonary disease (COPD) from July 2018 to July 2019 who also underwent polysomnography tests to assess obstructive sleep apnea (OSA). COPD patients who had an apnea-hypopnea index (AHI) ≥ 5/h were defined as OVS. COPD patients who had an AHI < 5/h were identified as pure COPD. Questionnaires were administered to evaluate depression and anxiety in all subjects. We compared the differences in scores between patients with OVS and pure COPD.

Results

Two hundred and fifty-two patients were included, 180 (71%) patients had OVS, while only 72 patients had pure COPD. In the OVS group, 54% of the patients had depression, and 77% of the patients had anxiety. We found that patients with OVS had higher anxiety (8.00 (4.00, 10.00) vs. 6.00 (3.00, 9.00), p = 0.018) and depression (8.00 (4.00, 10.00) vs. 5.50 (2.25, 10.00), p = 0.022) scores than patients with pure COPD. A higher proportion of patients with hypertension (41% vs. 21%) and coronary heart disease (14% vs. 4%) were found in the OVS group. Chest pain, COPD Assessment Test (CAT) score, and OVS were independent risk factors for depression (P<0.05). A positive correlation was shown between anxiety and depression (r=0.638, p < 0.001).

Conclusions

Anxiety and depression were more severe in patients with OVS than in patients with pure COPD. More attention should be paid to the mental health of OVS patients.

Trial Registration

ClinicalTrials.gov; URL: www.clinicaltrials.gov. NO.: NCT 03182309. Registered on June 9, 2017; https://clinicaltrials.gov/ct2/show/NCT03182309?term=NCT+03182309&draw=2&rank=1

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Data availability

This project will last for 5 years and multiple research centers are participating. Currently, this project is ongoing; therefore, these data cannot be shared until the project is fully completed, at which point they will be available from the corresponding author on reasonable request.

Abbreviations

COPD:

chronic obstructive pulmonary disease

OSA:

obstructive sleep apnea

OVS:

overlap syndrome

HADS:

Hospital Anxiety and Depression Scale

FEV1 :

forced expiratory volume in 1 s

FVC:

forced vital capacity

PSG:

polysomnography

AHI:

apnea-hypopnea index

BMI:

body mass index

CAT score:

COPD assessment test score

FEV1%pre:

the predicted percentage of FEV1

SpO2 :

pulse oxygen saturation

OR:

odds ratio

CI:

confidence interval

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Acknowledgements

We thank all the healthcare providers who worked in the hospital during the period of patient recruitment as well as all patients and their families who were involved in the study. We also thank the National Key Research and Development Program of China for its support.

Funding

This work was supported by the National Key Research and Development Program of China (NO. 2016YFC1304403) and Beijing Municipal Science and Technology Commission (NO. Z201100005520029).

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Author notes

  1. Zhiling Zhao and Dongmei Zhang contributed equally to this article

Authors and Affiliations

  1. Department of Respiratory and Critical Care Medicine, Beijing Institute of Respiratory Medicine and Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China

    Zhiling Zhao, Dongmei Zhang, Haiyan Sun, Xiaoshuang Lv, Junlin Lin, Junqing Liu, Xiaotao Wu, Xiheng Guo & Zhaohui Tong

  2. Biomedical Engineering School, Beijing Key Laboratory of Fundamental Research on Biomechanics in Clinical Application, Capital Medical University, Beijing, China

    Dandan Chang

  3. Department of Respiratory and Critical Care Medicine, Renmin Hospital of Wuhan University, Wuhan, China

    Ke Hu

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  1. Zhiling Zhao
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Contributions

X.H.G. and Z.H.T. conceived of and designed the study; Z.L.Z. and D.M.Z. were responsible for drafting and revision of the manuscript; H.Y.S., X.S.L., J.L.L, J.Q.L., and X.T.W. performed the data acquisition and interpretation. Z.L.Z. and D.D.C. were responsible for the data analysis, and K.H. performed the critical revision of the manuscript; X.H.G. and Z.H.T. gave final approval of the version to be published; X.H.G. had full access to all of the data in the study and assumes responsibility for the integrity of the data and the accuracy of the data analysis; all authors read and approved the final manuscript.

Corresponding authors

Correspondence to Xiheng Guo or Zhaohui Tong.

Ethics declarations

Ethics approval and consent to participate

This study was reviewed and approved by the Ethics Committee of Renmin Hospital of Wuhan University and Beijing Chao-Yang Hospital (No. 2017K-C014), and informed consent was obtained from the patients themselves or their legal guardians.

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Not applicable

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The authors declare no competing interests.

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Zhao, Z., Zhang, D., Sun, H. et al. Anxiety and depression in patients with chronic obstructive pulmonary disease and obstructive sleep apnea: the overlap syndrome. Sleep Breath 26, 1603–1611 (2022). https://doi.org/10.1007/s11325-021-02500-2

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  • DOI: https://doi.org/10.1007/s11325-021-02500-2

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