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Effects of CPAP and Mandibular Advancement Devices on depressive symptoms in patients with obstructive sleep apnea: a meta-analysis of randomized controlled trials

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Abstract

Purpose

Studies show that patients with obstructive sleep apnea (OSA) are more likely than the general population to have psychological disorders such as depression. However, it is less clear how OSA treatment affects this association. This meta-analysis aimed to assess whether or not continuous positive airway pressure (CPAP) and mandibular advancement devices (MADs) reduce depression symptoms in patients with OSA.

Methods

We searched Pubmed, Embase, Web of Science, and Cochrane Library from creating the databases until November 2022. Our analysis included RCTs that examined CPAP and MAD treatment effectiveness for depression in patients with OSA.

Results

We identified 17 CPAP studies comprising 1,931 patients for inclusion in the meta-analysis. The results of the meta-analysis using a fixed effects model found that CPAP improved depressed mood in patients with OSA relative to controls (SMD = 0.27;95% CI:0.18,0.36), with small heterogeneity among trials (I2 = 8.1% < 50%, P = 0.359). We performed subgroup analyses on three factors: the length of trial follow-up, patient adherence data, and depression assessment scales. The meta-analysis also identified six MAD studies involving 315 patients. According to this analysis, there was no heterogeneity between studies (I2 = 0%, P = 0.748). MADs did not significantly improve depression symptoms compared to controls, indicating a combined effect of SMD = 0.07 (95% CI: − 0.15,0.29), P > 0.05.

Conclusion

The present findings confirm that CPAP may improve depressive symptoms in patients with OSA. However, the review results suggest that MADs have no significant effect on depressive symptoms in patients with OSA, a finding that is different from the results of previous meta-analyses.

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Data availability

All data generated or analyzed during this study are included in this published article (and its supplementary information files).

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Funding

This work was supported by the Natural Science Foundation of Gansu Province (21JR1RA074).

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Authors and Affiliations

  1. The First Clinical Medical College of Lanzhou University, Lanzhou, 730000, China

    Wenli Fu, Leping Li, Sha Zhang & Shengfei Liu

  2. Department of Respiratory and Critical Care Medicine, The First Hospital of Lanzhou University, Lanzhou, 730000, China

    Weiying Liu

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This meta-analysis has been registered with PROSPERO, registration number CRD42022377501.

What is known

1. CPAP and MADs can improve many symptoms and disease severity in patients with OSA.

What is new

1. CPAP can reduce depressive symptoms in OSA patients, and MADs cannot significantly improve depressed mood in OSA patients.

2. When the duration of CPAP intervention was between 4 and 8 weeks and when used CPAP over 4 h per night, depressive symptoms in patients with OSA improved more markedly.

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Fu, W., Li, L., Zhang, S. et al. Effects of CPAP and Mandibular Advancement Devices on depressive symptoms in patients with obstructive sleep apnea: a meta-analysis of randomized controlled trials. Sleep Breath 27, 2123–2137 (2023). https://doi.org/10.1007/s11325-023-02829-w

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