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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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.
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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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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