Skip to main content

Advertisement

SpringerLink
Log in

Obstructive sleep apnea (OSA) and clinical depression—prevalence in a sleep center

  • Sleep Breathing Physiology and Disorders • Original Article
  • Published:
Sleep and Breathing Aims and scope Submit manuscript

Abstract

Background

This study aimed to determine the prevalence of clinical depression as defined by ICD-10 criteria in all patients with obstructive sleep apnea (OSA) referred to a sleep center.

Methods

Prospective general and sleep evaluations were conducted in 447 consecutive patients referred to our sleep center during the first quarter of 2008. Inclusion criteria were Apnea Hypopnea Index (AHI) > 9, completion of the Beck Depression Inventory (BDI-II) with a score ≥14 and World Health Organization WHO-5 Well-Being Index (WHO-5) ≤ 13. The subsequent psychiatric examination according to ICD-10 criteria was performed by in-house clinical sleep specialists.

Results

A total of 447 patients were surveyed, of whom 322 had an AHI > 9. Out of these, 85 met the combined screening criterion BDI II ≥ 14 and WHO-5 ≤ 13.

Eighty-one patients underwent a psychiatric examination by psychiatric sleep specialists. In 21.5 % of the sample, clinical depression was diagnosed. Other complaints existed in 12 % (n = 10); 7 % (n = 6) of patients had a different psychiatric diagnosis.

Conclusions

The prevalence of clinical depression according to ICD-10 criteria in a selected clinical sample (referred to the sleep center) was 21.5 %. Mood scales tend to overestimate complaints as compared to psychiatric consultation. Interdisciplinary cooperation is recommended for both OSA patients with symptoms of depression and depressed patients with treatment resistance.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Young THRFLBSPM (1996) The gender bias in sleep apnea diagnosis: are women missed because they have different symptoms? Arch Intern Med 156(21):2445–2451. doi:10.1001/archinte.1996.00440200055007

    Article  CAS  PubMed  Google Scholar 

  2. Young T, Palta M, Dempsey J et al (1993) The occurrence of sleep-disordered breathing among middle-aged adults. N Engl J Med 328(17):1230–1235. doi:10.1056/NEJM199304293281704

    Article  CAS  PubMed  Google Scholar 

  3. Guilleminault C, Eldridge FL, Tilkian A et al (1977) Sleep apnea syndrome due to upper airway obstruction: a review of 25 cases. Arch Intern Med 137(3):296–300

    Article  CAS  PubMed  Google Scholar 

  4. Reynolds CF3, Kupfer DJ, McEachran AB et al (1984) Depressive psychopathology in male sleep apneics. J Clin Psychiatry 45(7):287–290

    PubMed  Google Scholar 

  5. Reynolds CF3, Coble PA, Spiker DG et al (1982) Prevalence of sleep apnea and nocturnal myoclonus in major affective disorders: clinical and polysomnographic findings. J Nerv Ment Dis 170(9):565–567

    Article  PubMed  Google Scholar 

  6. Millman RP, Fogel BS, McNamara ME et al (1989) Depression as a manifestation of obstructive sleep apnea: reversal with nasal continuous positive airway pressure. J Clin Psychiatry 50(9):348–351

    CAS  PubMed  Google Scholar 

  7. Barnes M, McEvoy RD, Banks S et al (2004) Efficacy of positive airway pressure and oral appliance in mild to moderate obstructive sleep apnea. Am J Respir Crit Care Med 170(6):656–664. doi:10.1164/rccm.200311-1571OC

    Article  PubMed  Google Scholar 

  8. Goncalves MA, Guilleminault C, Ramos E et al (2005) Erectile dysfunction, obstructive sleep apnea syndrome and nasal CPAP treatment. Sleep Med 6(4):333–339. doi:10.1016/j.sleep.2005.03.001

    Article  CAS  PubMed  Google Scholar 

  9. Goncalves MA, Paiva T, Ramos E et al (2004) Obstructive sleep apnea syndrome, sleepiness, and quality of life*. Chest 125(6):2091–2096. doi:10.1378/chest.125.6.2091

    Article  PubMed  Google Scholar 

  10. Ishman SL, Cavey RM, Mettel TL et al (2010) Depression, sleepiness, and disease severity in patients with obstructive sleep apnea. Laryngoscope 120(11):2331–2335. doi:10.1002/lary.21111

    Article  PubMed  Google Scholar 

  11. McCall WV, Harding D, O’Donovan C (2006) Correlates of depressive symptoms in patients with obstructive sleep apnea. J Clin Sleep Med 2(4):424–426

    PubMed  Google Scholar 

  12. Schwartz DJ, Kohler WC, Karatinos G (2005) Symptoms of depression in individuals with obstructive sleep apnea may be amenable to treatment with continuous positive airway pressure. Chest 128(3):1304–1309. doi:10.1378/chest.128.3.1304

    Article  PubMed  Google Scholar 

  13. Munoz A, Mayoralas LR, Barbe F et al (2000) Long-term effects of CPAP on daytime functioning in patients with sleep apnoea syndrome. Eur Respir J 15(4):676–681

    Article  CAS  PubMed  Google Scholar 

  14. Vandeputte M, de WA (2003) Sleep disorders and depressive feelings: a global survey with the Beck depression scale. Sleep Med 4(4):343–345

    Article  PubMed  Google Scholar 

  15. Means M, Lichstein K, Edinger J et al (2003) Changes in depressive symptoms after continuous positive airway pressure treatment for obstructive sleep apnea. Sleep Breath 7(1):31–42. doi:10.1007/s11325-003-0031-x

    Article  PubMed  Google Scholar 

  16. Akashiba T, Kawahara S, Akahoshi T et al (2002) Relationship between quality of life and mood or depression in patients with severe obstructive sleep apnea syndrome. Chest 122(3):861–865

    Article  PubMed  Google Scholar 

  17. Peppard PE, Szklo-Coxe M, Hla KM et al (2006) Longitudinal association of sleep-related breathing disorder and depression. Arch Intern Med 166(16):1709–1715. doi:10.1001/archinte.166.16.1709

    Article  PubMed  Google Scholar 

  18. Kawahara S, Akashiba T, Akahoshi T et al (2005) Nasal CPAP improves the quality of life and lessens the depressive symptoms in patients with obstructive sleep apnea syndrome. Intern Med 44(5):422–427

    Article  PubMed  Google Scholar 

  19. Lewis KE, Seale L, Bartle IE et al (2004) Early predictors of CPAP use for the treatment of obstructive sleep apnea. Sleep 27(1):134–138

    Article  PubMed  Google Scholar 

  20. Kjelsberg FN, Ruud EA, Stavem K (2005) Predictors of symptoms of anxiety and depression in obstructive sleep apnea. Sleep Med 6(4):341–346. doi:10.1016/j.sleep.2005.02.004

    Article  PubMed  Google Scholar 

  21. Doherty LS, Kiely JL, Lawless G et al (2003) Impact of nasal continuous positive airway pressure therapy on the quality of life of bed partners of patients with obstructive sleep apnea syndrome. Chest 124(6):2209–2214

    Article  PubMed  Google Scholar 

  22. Shepertycky MR, Banno K, Kryger MH (2005) Differences between men and women in the clinical presentation of patients diagnosed with obstructive sleep apnea syndrome. Sleep 28(3):309–314

    PubMed  Google Scholar 

  23. Yamamoto H, Akashiba T, Kosaka N et al (2000) Long-term effects nasal continuous positive airway pressure on daytime sleepiness, mood and traffic accidents in patients with obstructive sleep apnoea. Respir Med 94(1):87–90. doi:10.1053/rmed.1999.0698

    Article  CAS  PubMed  Google Scholar 

  24. Mosko S, Zetin M, Glen S et al (1989) Self-reported depressive symptomatology, mood ratings, and treatment outcome in sleep disorders patients. J Clin Psychol 45(1):51–60

    Article  CAS  PubMed  Google Scholar 

  25. Sharafkhaneh A, Giray N, Richardson P et al (2005) Association of psychiatric disorders and sleep apnea in a large cohort. Sleep 28(11):1405–1411

    Article  PubMed  Google Scholar 

  26. El-Sherbini AM, Bediwy AS, El-Mitwalli A (2011) Association between obstructive sleep apnea (OSA) and depression and the effect of continuous positive airway pressure (CPAP) treatment. Neuropsychiatr Dis Treat 7:715–721. doi:10.2147/NDT.S26341

    PubMed  PubMed Central  Google Scholar 

  27. Dahlöf P, Ejnell H, Hällström T et al (2000) Surgical treatment of the sleep apnea syndrome reduces associated major depression. International Journal of Behavioral Medicine 7(1):73–88

    Article  Google Scholar 

  28. Mackinger HF, Svaldi JJ (2004) Autobiographical memory predicts cognitive but not somatic change in sleep apnea patients vulnerable for affective disorder. J Affect Disord 81(1):17–22. doi:10.1016/S0165-0327(03)00170-8

    Article  PubMed  Google Scholar 

  29. Sforza E, de Saint Hilaire Z, Pelissolo A et al (2002) Personality, anxiety and mood traits in patients with sleep-related breathing disorders: effect of reduced daytime alertness. Sleep Med 3(2):139–145

    Article  PubMed  Google Scholar 

  30. Ohayon MM (2003) The effects of breathing-related sleep disorders on mood disturbances in the general population. J Clin Psychiatry 64(10):1195

    Article  PubMed  Google Scholar 

  31. Sanchez AI, Buela-Casal G, Bermudez MP et al (2001) The effects of continuous positive air pressure treatment on anxiety and depression levels in apnea patients. Psychiatry Clin Neurosci 55(6):641–646

    Article  CAS  PubMed  Google Scholar 

  32. Saunamaki T, Jehkonen M (2007) Depression and anxiety in obstructive sleep apnea syndrome: a review. Acta Neurol Scand 116(5):277–288. doi:10.1111/j.1600-0404.2007.00901.x

    Article  CAS  PubMed  Google Scholar 

  33. Aikens JE, Caruana-Montaldo B, Vanable PA et al (1999) MMPI correlates of sleep and respiratory disturbance in obstructive sleep apnea. Sleep 22(3):362–369

    Article  CAS  PubMed  Google Scholar 

  34. Aikens JE, Mendelson WB (1999) A matched comparison of MMPI responses in patients with primary snoring or obstructive sleep apnea. Sleep 22(3):355–359

    Article  CAS  PubMed  Google Scholar 

  35. Aikens JE, Vanable PA, Tadimeti L et al (1999) Differential rates of psychopathology symptoms in periodic limb movement disorder, obstructive sleep apnea, psychophysiological insomnia, and insomnia with psychiatric disorder. Sleep 22(6):775–780

    Article  CAS  PubMed  Google Scholar 

  36. Aikens JE, Mendelson WB, Baehr EK (2000) Replicability of psychometric differences between obstructive sleep apnea, primary snoring, and periodic limb movement disorder. J Sleep Hypnosis 4:211–215

    Google Scholar 

  37. Choi J-A, Yoon I-Y, Han E-G et al (2011) Subjective and objective CPAP compliance in patients with obstructive sleep apnea syndrome. Sleep Medicine Research 2(2):63–68

    Article  Google Scholar 

  38. Borak J, Cieslicki JK, Koziej M et al (1996) Effects of CPAP treatment on psychological status in patients with severe obstructive sleep apnoea. J Sleep Res 5(2):123–127

    Article  CAS  PubMed  Google Scholar 

  39. Henkel V, Mergl R, Coyne JC et al (2004) Screening for depression in primary care: will one or two items suffice? Eur Arch Psychiatry Clin Neurosci 254(4):215–223. doi:10.1007/s00406-004-0476-3

    Article  PubMed  Google Scholar 

  40. Henkel V, Mergl R, Kohnen R et al (2003) Identifying depression in primary care: a comparison of different methods in a prospective cohort study. BMJ 326(7382):200–201

    Article  PubMed  PubMed Central  Google Scholar 

  41. Johns MW (1991) A new method for measuring daytime sleepiness: the Epworth sleepiness scale. Sleep 14(6):540–545

    Article  CAS  PubMed  Google Scholar 

  42. Bardwell WA, Moore P, Ancoli-Israel S et al (2003) Fatigue in obstructive sleep apnea: driven by depressive symptoms instead of apnea severity? Am J Psychiatry 160(2):350–355

    Article  PubMed  Google Scholar 

  43. Bixler EO, Vgontzas AN, Lin H-M et al (2005) Excessive daytime sleepiness in a general population sample: the role of sleep apnea, age, obesity, diabetes, and depression. J Clin Endocrinol Metab 90(8):4510–4515. doi:10.1210/jc.2005-0035

    Article  CAS  PubMed  Google Scholar 

  44. Edinger JD, Carwile S, Miller P et al (1994) Psychological status, syndromatic measures, and compliance with nasal CPAP therapy for sleep apnea. Percept Mot Skills 78(3 Pt 2):1116–1118

    Article  CAS  PubMed  Google Scholar 

  45. Dominici M, Gomes M (2009) Obstructive sleep apnea (OSA) and depressive symptoms. Arq Neuropsiquiatr 67(1):35–39

    Article  PubMed  Google Scholar 

  46. Wheaton AG, Perry GS, Chapman DP et al (2012) Sleep disordered breathing and depression among U.S. adults: national health and nutrition examination survey, 2005-2008. Sleep 35(4):461–467. doi:10.5665/sleep.1724

    Article  PubMed  PubMed Central  Google Scholar 

  47. Aloia MS, Arnedt JT, Smith L et al (2005) Examining the construct of depression in obstructive sleep apnea syndrome. Sleep Med 6(2):115–121. doi:10.1016/j.sleep.2004.09.003

    Article  PubMed  Google Scholar 

  48. Yang CK, Yang KS, Clerk A (2011) Perceived stress, depression, and coping strategies in patients with sleep-related breathing disorder. Sleep Medicine Research 2(2):54–62

    Article  Google Scholar 

  49. Hattori M, Kitajima T, Mekata T et al (2009) Risk factors for obstructive sleep apnea syndrome screening in mood disorder patients. Psychiatry Clin Neurosci 63(3):385–391. doi:10.1111/j.1440-1819.2009.01956.x

    Article  PubMed  Google Scholar 

  50. Lang FU, Hösch H, Seibert H et al (2011) Obstruktives Schlaf-Apnoe-Syndrom als Ursache einer atypischen depression (obstructive sleep apnoea syndrome as the cause of atypical depression). Fortschr Neurol Psychiatr 79(9):531–534. doi:10.1055/s-0031-1281625

    Article  CAS  PubMed  Google Scholar 

  51. Farney R, Lugo A, Jensen R et al (2004) Simultaneous use of antidepressant and antihypertensive medications increases likelihood of diagnosis of obstructive sleep apnea syndrome. Chest 125(4):1279–1285

    Article  PubMed  Google Scholar 

  52. Smith R, Ronald J, Delaive K et al (2002) What are obstructive sleep apnea patients being treated for prior to this diagnosis? Chest 121(1):164–172

    Article  PubMed  Google Scholar 

  53. Smith S, Sullivan K, Hopkins W et al (2004) Frequency of insomnia report in patients with obstructive sleep apnoea hypopnea syndrome (OSAHS). Sleep Med 5(5):449–456. doi:10.1016/j.sleep.2004.03.005

    Article  PubMed  Google Scholar 

  54. Teodorescu MC, Avidan AY, Teodorescu M et al (2007) Sleep medicine content of major medical textbooks continues to be underrepresented. Sleep Med 8(3):271–276

    Article  PubMed  Google Scholar 

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

    PubMed  PubMed Central  Google Scholar 

  56. Edwards C, Mukherjee S, Simpson L et al (2015) Depressive symptoms before and after treatment of obstructive sleep apnea in men and women. J Clin Sleep Med 11(9):1029–1038. doi:10.5664/jcsm.5020

    PubMed  PubMed Central  Google Scholar 

  57. Habukawa M, Uchimura N, Kakuma T et al (2010) Effect of CPAP treatment on residual depressive symptoms in patients with major depression and coexisting sleep apnea: contribution of daytime sleepiness to residual depressive symptoms. Sleep Med 11(6):552–557. doi:10.1016/j.sleep.2010.02.007

    Article  PubMed  Google Scholar 

  58. Wells RD, Freedland KE, Carney RM et al (2007) Adherence, reports of benefits, and depression among patients treated with continuous positive airway pressure. Psychosom Med 69(5):449–454. doi:10.1097/psy.0b013e318068b2f7

    Article  PubMed  Google Scholar 

  59. Schröder CM, O’Hara R (2005) Depression and obstructive sleep apnea (OSA). Ann Gen Psychiatry 4:13. doi:10.1186/1744-859X-4-13

    Article  PubMed  PubMed Central  Google Scholar 

  60. Quintana-Gallego E, Carmona-Bernal C, Capote F et al (2004) Gender differences in obstructive sleep apnea syndrome: a clinical study of 1166 patients. Respir Med 98(10):984–989

    Article  PubMed  Google Scholar 

  61. Pillar G, Lavie P (1998) Psychiatric symptoms in sleep apnea syndrome: effects of gender and respiratory disturbance index. Chest 114(3):697–703

    Article  CAS  PubMed  Google Scholar 

  62. Ferrari AJ, Charlson FJ, Norman RE et al (2013) The epidemiological modelling of major depressive disorder: application for the global burden of disease study 2010. PLoS One 8(7):e69637. doi:10.1371/journal.pone.0069637

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  63. Wharton W, Gleason CE, Olson SRMS et al (2012) Neurobiological underpinnings of the estrogen—mood relationship. Curr Psychiatry Rev 8(3):247–256. doi:10.2174/157340012800792957

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  64. Ong JC, Gress JL, San Pedro-Salcedo MG et al (2009) Frequency and predictors of obstructive sleep apnea among individuals with major depressive disorder and insomnia. J Psychosom Res 67(2):135–141. doi:10.1016/j.jpsychores.2009.03.011

    Article  PubMed  PubMed Central  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Clinic for sleep medicine, Badstrasse 33, 5330, Bad Zurzach, Switzerland

    Jens Acker

  2. University Clinic for Psychiatry and Psychotherapy, Paracelsus Private Medical University, Nuremberg, Germany

    K Richter, A Piehl & G Niklewski

  3. Faculty of Social Sciences, University of Applied Sciences Georg Simon Ohm, Nuremberg, Germany

    K Richter

  4. Group practice for Respiratory Medicine Dr. J. Herold und A. Kaa, Roth, Germany

    J Herold

  5. University Clinic for Respiratory Medicine, Allergology and Sleep Medicine, Paracelsus Private Medical University, Nuremberg, Germany

    JH Ficker

Authors
  1. Jens Acker
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. K Richter
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. A Piehl
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. J Herold
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. JH Ficker
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. G Niklewski
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Jens Acker.

Ethics declarations

Funding

Heinen und Löwenstein (manufacturer of CPAC devices) provided financial support in the form of third-party funding. The sponsor had no role in the design or conduct of this research.

Conflict of interest

All authors certify that they have no affiliations with or involvement in any organization or entity with any financial interest (such as honoraria; educational grants; participation in speakers’ bureaus; membership, employment, consultancies, stock ownership, or other equity interest; and expert testimony or patent-licensing arrangements), or non-financial interest (such as personal or professional relationships, affiliations, knowledge or beliefs) in the subject matter or materials discussed in this manuscript.

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.

Informed consent

Informed consent was obtained from all individual participants included in the study.

Additional information

Richter K contributed equally to this work.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Acker, J., Richter, K., Piehl, A. et al. Obstructive sleep apnea (OSA) and clinical depression—prevalence in a sleep center. Sleep Breath 21, 311–318 (2017). https://doi.org/10.1007/s11325-016-1411-3

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11325-016-1411-3

Keywords

Search

Navigation