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Utility of the Berlin questionnaire for predicting obstructive sleep apnea in individuals with treatment-resistant depression

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Abstract

Purpose

Obstructive sleep apnea is a disabling sleep disorder characterized by obstructions or near obstructions of the upper airway. Sleep apnea shares many common features with major depressive disorder, which is a serious psychiatric disorder that can persist despite multiple treatment attempts. The current study utilizes baseline data from a study designed to evaluate the effectiveness of continuous positive airway pressure treatment in patients with comorbid treatment-resistant depression and sleep apnea. The aim of this study is to examine the effectiveness of the Berlin questionnaire in predicting which individuals with treatment-resistant depression have obstructive sleep apnea.

Methods

Eighty-two outpatients with treatment-resistant depression completed the Berlin questionnaire and underwent overnight polysomnography to determine whether they were suffering from undiagnosed obstructive sleep apnea.

Results

Scoring in the high-risk category on the Berlin questionnaire predicted an apnea/hypopnea index greater than 5 with a sensitivity of 25 % and a specificity of 85.4 %, an apnea/hypopnea index greater than 10 with a sensitivity of 24.5 % and a specificity of 91.7 %, and an apnea/hypopnea index greater than 15 with a sensitivity of 22.2 % and a specificity of 92.9 %. The Berlin questionnaire was better at predicting the presence of sleep apnea in our sample of predominantly pre-menopausal women than men, and category 2 of the questionnaire (daytime somnolence) was the poorest predictor of sleep apnea.

Conclusions

The Berlin questionnaire appears to be a valid instrument for ruling out obstructive sleep apnea in treatment-resistant depression and may be a helpful tool in assisting with the allocation of diagnostic resources.

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References

  1. Young T, Peppard PE, Gottlieb DJ (2002) Epidemiology of obstructive sleep apnea: a population health perspective. Am J Respir Crit Care Med 165:1217–1239

    Article  PubMed  Google Scholar 

  2. Young T, Palta M, Dempsey J, Skatrud J, Weber S, Badr S (1993) The occurrence of sleep-disordered breathing among middle-aged adults. N Eng. J Med 328:1230–1235

    Article  CAS  Google Scholar 

  3. Strollo PJ, Rogers RM (1996) Obstructive sleep apnea. N Eng J Med 334:99–104

    Article  Google Scholar 

  4. Lee W, Nagubadi S, Kryger MH, Mokhlesi B (2008) Epidemiology of obstructive sleep apnea: a population-based perspective. Expert Rev Resp Med 2(3):349–364

    Article  Google Scholar 

  5. Mannarino MR, Filippo FD, Pirro M (2012) Obstructive sleep apnea syndrome. Eur J Intern Med 23:586–593, Sleep, 22, 6: 749–755

    Article  PubMed  Google Scholar 

  6. Young TB, Evans L, Finn L, Palta M (1997) Estimation of the clinically diagnosed proportion of sleep apnea syndrome in middle-aged men and women. Sleep 20:705–706

    PubMed  CAS  Google Scholar 

  7. Kapur V, Blough DK, Sandblom RE, Hert R, de Maine JB, Sullivan SD, Psaty BM (1999) The medical cost of undiagnosed sleep apnea. Sleep 22(6):749–55

    PubMed  CAS  Google Scholar 

  8. Means MK, Lichstein KL, Edinger JD, Taylor DJ, Durrence H, Husain AM, Aguillard RN, Radtke RA (2003) Changes in depressive symptoms after continuous positive airway pressure treatment for obstructive sleep apnea. Sleep Breath 7(1):31–42

    Article  PubMed  Google Scholar 

  9. Jackson ML, Stough C, Howard ME, Spong J, Downey LA, Thompson B (2011) The contribution of fatigue and sleepiness to depression in patients attending the sleep laboratory for evaluation of obstructive sleep apnea. Sleep Breath 15:439–445

    Article  PubMed  Google Scholar 

  10. Rush AJ, Trivedi MH, Wisniewski SR, Nierenberg AA, Stewart JW, Warden D, Niederehe G, Thase ME, Lavori PW, Lebowitz BD, McGrath PJ, Rosenbaum JF, Sackeim HA, Kupfer DJ, Luther J, Fava M (2006) Acute and longer-term outcomes in depressed outpatients requiring one or several treatment steps: a STAR*D report. Am J Psychiatry 163:1905–1917

    Article  PubMed  Google Scholar 

  11. Thase ME, Rush AJ (1995) Treatment resistant depression. In: Bloom FE, Kupfer DJ (eds) Psychopharmacology: the fourth generation of progress. Raven Press, New York, pp 1081–1097

    Google Scholar 

  12. Fava M (2003) Diagnosis and definition of treatment-resistant depression. Biol Psychiat 53:649–659

    Article  PubMed  Google Scholar 

  13. Berlim MT, Turecki G (2007) Definition, assessment, and staging of treatment-resistant refractory major depression: a review of current concepts and methods. Can J Psychiat 52(1):46–54

    Google Scholar 

  14. Wijeratne C, Sachdev P (2008) Treatment-resistant depression: critique of current approaches. Aust NZ J Psychiat 42:751–762

    Article  Google Scholar 

  15. Fang Y, Yuan C, Xu Y, Chen J, Wu Z, Cao L, Yi Z, Hong W, Wang Y, Jiang K, Gao K, Cui X, Nierenberg AA, OPERATION Study Team (2010) Comparisons of the efficacy and tolerability of extended-release venlafaxine, mirtazapine, and paroxetine in treatment-resistant depression: a double-blind, randomized pilot study in a Chinese population. J Clin Psychopharmacol 30:357–364

    Article  PubMed  CAS  Google Scholar 

  16. Li Z, Zhang Y, Wang Z, Chen J, Fan J, Guan Y, Zhang C, Yuan C, Hong W, Wang Y, Wu Z, Huang J, Hu Y, Cao L, Yi Z, Cui D, Yu S, Fang Y (2013) The role of BDNF, NTRK2 gene and their interaction in development of treatment-resistant depression: data from multicenter, prospective, longitudinal clinic practice. J Psychiatr Res 47:8–14

    Article  PubMed  Google Scholar 

  17. Petersen T, Papakostas GI, Mahal Y, Guyker WM, Beaumont EC, Alpert JE, Fava M, Nierenberg AA (2004) Psychosocial functioning in patients with treatment resistant depression. Eur Psychiat 19:196–201

    Article  Google Scholar 

  18. Kornstein SG, Schneider RK (2001) Clinical features of treatment-resistant depression. J Clin Psychiat 62:18–25

    CAS  Google Scholar 

  19. Hsueh KL, Lin PY (2010) Treatment-resistant depression prior to the diagnosis of cryptococcal meningitis: a case report. Gen Hosp Psychiatry 32:560.e9–560.e10

    Article  Google Scholar 

  20. Kulmatycki KM, Jamali F (2006) Drug disease interactions: role of inflammatory mediators in depression and variability in antidepressant drug response. J Pharm Pharmaceut Sci 9:292–306

    CAS  Google Scholar 

  21. Samuels BA, Leonardo ED, Gadient R, Williams A, Zhou J, David DJ, Gardier AM, Wong EHF, Hen R (2011) Modeling treatment-resistant depression. Neuropharmacology 61:408–413

    Article  PubMed  CAS  Google Scholar 

  22. Ejaz SM, Khawaja IS, Bhatia S, Hurwitz TD (2011) Obstructive sleep apnea and depression: a review. Innov Clin Neurosci 8(8):17–25

    PubMed  Google Scholar 

  23. Wheaton AG, Perry GS, Chapman DP, Croft JB (2011) Sleep disordered breathing and depression among U.S. adults: National Health and Nutrition Examination Survey, 2005–2008. Sleep 35(4):461–467

    Google Scholar 

  24. Riley RW, Powell NB, Guilleminault C, Clerk A, Troel R (1995) Obstructive sleep apnea: trends in therapy. West J Med 162:143–148

    PubMed  CAS  Google Scholar 

  25. Netzer NC, Stoohs RA, Netzer CM, Clark K, Strohl KP (1999) Using the Berlin Questionnaire to identify patients at risk for the sleep apnea syndrome. Ann Intern Med 131:485–491

    Article  PubMed  CAS  Google Scholar 

  26. Abrishami A, Khajehdehi A, Chung F (2010) A systematic review of screening questionnaires for obstructive sleep apnea. Can J Anesth 57:423–438

    Article  PubMed  Google Scholar 

  27. Ahmadi N, Chung SA, Gibbs A, Shapiro CM (2008) The Berlin questionnaire for sleep apnea in a sleep clinic population: relationship to polysomnographic measurement of respiratory disturbance. Sleep Breath 12:39–45

    Article  PubMed  Google Scholar 

  28. Sforza E, Chouchou F, Pichot V, Herrmann F, Barthelemy JC, Roche F (2011) Is the Berlin questionnaire a useful tool to diagnose obstructive sleep apnea in the elderly? Sleep Med 12:142–146

    Article  PubMed  Google Scholar 

  29. Moreno CRC, Cavalho FA, Lorenzi C, Matuzaki LS, Prezotti S, Bighetti P, Louzada FM, Lorenzi-Filbo G (2004) High risk for obstructive sleep apnea in truck drivers estimated by the Berlin questionnaire: prevalence and associated factors. Chronobiol Int 21:871–879

    Article  PubMed  CAS  Google Scholar 

  30. Chung F, Yegneswaran B, Liao P, Chung SA, Vairavanathan S, Islam S, Khajehdehi A, Shapiro CM (2008) Validation of the Berlin questionnaire and American Society of Anesthesiologists checklist as screening tools for obstructive sleep apnea in surgical patients. Anesthesiology 108(5):823–830

    Google Scholar 

  31. Srijithesh PR, Shukla G, Srivastav A, Goyal V, Singh S, Behari M (2011) Validity of the Berlin Questionnaire in identifying obstructive sleep apnea syndrome when administered to the informants of stroke patients. J Clin Neurosci 18:340–343

    Article  PubMed  CAS  Google Scholar 

  32. Sagaspe P, Leger D, Taillard J, Bayon V, Chaumet G, Philip P (2010) Might the Berlin Sleep Questionnaire applied to bed partners be used to screen sleep apneic patients? Sleep Med 11:479–483

    Article  PubMed  Google Scholar 

  33. Martinez D, da Silva RP, Klein C, Flori CZ, Massierer D, Cassol CM, Bos AJG, Gus M (2012) High risk for sleep apnea in the Berlin questionnaire and coronary artery disease. Sleep Breath 16:89–94

    Article  PubMed  Google Scholar 

  34. Enciso R, Clark GT (2011) Comparing the Berlin and the ARES questionnaire to identify patients with obstructive sleep apnea in a dental setting. Sleep Breath 15:83–89

    Article  PubMed  Google Scholar 

  35. Ahmadi N, Chung SA, Gibbs A, Shapiro CM (2008) The Berlin questionnaire for sleep apnea in a sleep clinic population: relationship to polysomnographic measurement of respiratory disturbance. Sleep Breath 12:39–45

    Article  PubMed  Google Scholar 

  36. Hamilton M (1967) Development of a rating scale for primary depressive illness. Br J Soc Clin Psychol 6:278–296

    Article  PubMed  CAS  Google Scholar 

  37. Iber C, Ancoli-Israel S, Chesson A, Quan S (2007) The AASM manual for the scoring of sleep and associated events: rules, terminology and technical specifications, 1st edn. American Academy of Sleep Medicine, Westchester

    Google Scholar 

  38. Reynolds RF, Obermeyer CM (2005) Age at natural menopause in Spain and the United States: results from the Dames Project. Am J Hum Biol 17:331–340

    Article  PubMed  Google Scholar 

  39. Young T, Finn L, Austin D, Peterson A (2003) Menopausal status and sleep-disordered breathing in the Wisconsin Sleep Cohort Study. Am J Respir Crit Care Med 167:1181–1185

    Article  PubMed  Google Scholar 

  40. D’Ambrosio C, Stachenfeld NS, Pisani M, Mohsenin V (2005) Sleep breathing, and menopause: the effect of fluctuating estrogen and progesterone on sleep and breathing in women. Gender Med 2(4):238–245

    Article  Google Scholar 

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Acknowledgments

We would like to thank the research coordinators from the Mood Disorders Research and Treatment Service at Providence Care, Mental Health Services in Kingston, Ontario, as well as Dave Summers and Jonathon Sawatsky for their hard work in administration duties and in collecting and organizing the data. We would also like to thank ResMed whose financial support was critical to this study.

Conflict of interest

No authors have any conflicts of interest to report.

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Authors and Affiliations

  1. Department of Psychology, Queen’s University, Kingston, Canada

    Michael W. Best & Christopher R. Bowie

  2. Department of Psychiatry, Queen’s University, Kingston, Canada

    Roumen Milev, Christopher R. Bowie & Ruzica Jokic

  3. Department of Respiratory and Critical Care, Queen’s University, Kingston, Canada

    Michael Fitzpatrick

  4. Centre for Neuroscience, Queen’s University, Kingston, Canada

    Roumen Milev & Christopher R. Bowie

  5. Mental Health Services, Providence Care, Kingston, Canada

    Roumen Milev & Ruzica Jokic

Authors
  1. Michael W. Best
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  2. Michael Fitzpatrick
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  3. Roumen Milev
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  4. Christopher R. Bowie
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  5. Ruzica Jokic
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Correspondence to Ruzica Jokic.

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Best, M.W., Fitzpatrick, M., Milev, R. et al. Utility of the Berlin questionnaire for predicting obstructive sleep apnea in individuals with treatment-resistant depression. Sleep Breath 17, 1221–1227 (2013). https://doi.org/10.1007/s11325-013-0827-2

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  • DOI: https://doi.org/10.1007/s11325-013-0827-2

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