Edwards Cass, Mukherjee Sutapa, Simpson Laila, Palmer Lyle J, Almeida Osvaldo P, Hillman David R
School of Surgery, University of Western Australia, Crawley, Australia.
West Australian Sleep Disorders Research Institute, Queen Elizabeth II Medical Centre, Nedlands, Australia.
J Clin Sleep Med. 2015 Sep 15;11(9):1029-38. doi: 10.5664/jcsm.5020.
To determine prevalence of depressive symptoms in obstructive sleep apnea (OSA) and the impact of OSA treatment on depression scores.
Consecutive new patients referred for investigation of suspected OSA were approached. Consenting patients completed a patient health questionnaire (PHQ-9) for depressive symptoms when attending for laboratory polysomnography. Those with moderate/severe (apneahypopnea index [AHI] ≥ 15 events/h) and/or symptomatic mild OSA (AHI 5-14.99 events/h) were offered continuous positive airway pressure (CPAP) therapy. PHQ-9 was repeated after 3 months of CPAP with compliance recorded. Of a maximum PHQ-9 score of 27, a cut point ≥ 10 (PHQ-9 ≥ 10) was used to indicate presence of clinically significant depressive symptoms.
A total of 426 participants (243 males) were recruited. Mean ± standard deviation body mass index (BMI) was 32.1 ± 7.1 kg/m2 and AHI 33.6 ± 28.9 events/h. PHQ-9 was 10.5 ± 6.1 and independently related to AHI (p < 0.001) and BMI (p < 0.001). In those without OSA, PHQ-9 ≥ 10 was more common in women, but no gender difference was evident with OSA. Of 293 patients offered CPAP, 228 were compliant (mean nightly use > 5 h) over 3 months of therapy. In them, with therapy, AHI decreased from 46.7 ± 27.4 to 6.5 ± 1.6 events/h, PHQ-9 from 11.3 ± 6.1 to 3.7 ± 2.9 and PHQ-9 ≥ 10 from 74.6% to 3.9% (p < 0.001 in each case). Magnitude of change in PHQ-9 was similar in men and women. Antidepressant use was constant throughout.
Depressive symptoms are common in OSA and related to its severity. They improve markedly with CPAP, implying a relationship to untreated OSA.
确定阻塞性睡眠呼吸暂停（OSA）患者中抑郁症状的患病率以及OSA治疗对抑郁评分的影响。
对因疑似OSA前来检查的连续新患者进行研究。同意参与的患者在接受实验室多导睡眠图检查时填写患者健康问卷（PHQ - 9）以评估抑郁症状。那些患有中度/重度（呼吸暂停低通气指数[AHI]≥15次/小时）和/或有症状的轻度OSA（AHI 5 - 14.99次/小时）的患者接受持续气道正压通气（CPAP）治疗。在CPAP治疗3个月后重复进行PHQ - 9评估，并记录依从性。PHQ - 9的最高分为27分，以≥10分（PHQ - 9≥10）作为存在具有临床意义的抑郁症状的切点。
共招募了426名参与者（243名男性）。平均体重指数（BMI）±标准差为32.1±7.1kg/m²，AHI为33.6±28.9次/小时。PHQ - 9评分为10.5±6.1，且与AHI（p < 0.001）和BMI（p < 0.001）独立相关。在没有OSA的患者中，PHQ - 9≥10在女性中更常见，但在OSA患者中没有明显的性别差异。在293名接受CPAP治疗的患者中，228名在3个月的治疗期间依从性良好（平均每晚使用时间>5小时）。在这些患者中，随着治疗，AHI从46.7±27.4降至6.5±1.6次/小时，PHQ - 9从11.3±6.1降至3.7±2.9，PHQ - 9≥10的比例从74.6%降至3.9%（每种情况p < 0.001）。男性和女性的PHQ - 9变化幅度相似。整个过程中抗抑郁药的使用情况保持不变。
抑郁症状在OSA患者中很常见，且与病情严重程度相关。CPAP治疗可使其明显改善，这意味着与未治疗的OSA存在关联。
