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Depressive symptoms are associated with poor sleep quality rather than apnea-hypopnea index or hypoxia during sleep in patients with obstructive sleep apnea

  • Psychiatrics • Original Article
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Abstract

Purpose

We examined factors, including the severity of obstructive sleep apnea (OSA), that were associated with depressive symptoms and excessive daytime sleepiness in OSA patients.

Methods

We retrospectively reviewed data of 1203 subjects (861 men, mean age 48.2 years) who completed self-reported questionnaires and underwent polysomnography between September 2005 and May 2016 at the Center for Sleep and Chronobiology at Seoul National University Hospital. We compared scores on the Beck Depression Inventory (BDI) and Epworth sleepiness scale (ESS) between OSA and control groups. Analyses for OSA subgroups were classified by severity, and partial correlations were performed.

Results

BDI scores were higher in the OSA than in the control group (12.3 ± 7.6 vs. 10.1 ± 6.2, p = 0.001). There were differences in ESS scores among the mild, moderate, and severe OSA subgroups (p < 0.001), but not in BDI scores (p = 0.236). After adjusting for age, gender, and BMI, BDI in the OSA group correlated positively with wake after sleep onset (WASO; p = 0.014) and sleep latency (SL; p < 0.001), negatively with total sleep time (TST; p < 0.001) and sleep efficiency (SE; p = 0.001), but not with the apnea-hypopnea index (AHI; p = 0.387) or average O2 (p = 0.542). ESS in the OSA group correlated positively with TST (p < 0.001), SE (p < 0.001), and AHI (p < 0.001) and negatively with WASO (p = 0.010), SL (p < 0.001), and average O2 (p < 0.001).

Conclusions

In this study, patients with OSA had more depressive symptoms than those without OSA. Daytime sleepiness in OSA patients was related to the severity of OSA as well as sleep propensity. However, depressive symptoms in OSA patients were associated with poor sleep quality rather than OSA severity. Depressive symptoms in OSA may be treated by modulating the sleep architecture and sleep quality.

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Authors and Affiliations

  1. Department of Psychiatry and Center for Sleep and Chronobiology, Seoul National University College of Medicine, Seoul, Republic of Korea

    Sang Hun Lee, Yu Jin Lee, Soohyun Kim & Do-Un Jeong

  2. Department of Psychiatry, Eulji University School of Medicine, Eulji General Hospital, Seoul, Republic of Korea

    Jae-Won Choi

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  1. Sang Hun Lee
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  2. Yu Jin Lee
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Correspondence to Yu Jin Lee.

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The authors declare that they have no conflict of interest including relevant financial interests, activities, relationships, and affiliations.

Ethical approval

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 study protocol was approved by the institutional review board and ethical committee of Seoul National University Hospital.

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Lee, S.H., Lee, Y.J., Kim, S. et al. Depressive symptoms are associated with poor sleep quality rather than apnea-hypopnea index or hypoxia during sleep in patients with obstructive sleep apnea. Sleep Breath 21, 997–1003 (2017). https://doi.org/10.1007/s11325-017-1550-1

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