Waterman Lauren, Stahl Sarah T, Buysse Daniel J, Lenze Eric J, Blumberger Daniel, Mulsant Benoit, Butters Meryl, Gebara Marie Anne, Reynolds Charles F, Karp Jordan F
Department of Psychiatry, Western Psychiatric Institute and Clinic, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
Department of Psychiatry, Washington University in St. Louis, St. Louis, MO, USA.
Depress Anxiety. 2016 Dec;33(12):1107-1113. doi: 10.1002/da.22555. Epub 2016 Sep 16.
Obstructive sleep apnea (OSA) is frequently comorbid with late-life depression. The purpose of this project was to determine, using a sample of older adults with major depressive disorder, whether patient-reported diagnosis of OSA was associated with rate of response to venlafaxine.
Participants from this multisite study were adults ≥60 years old (n = 468) with major depressive disorder and a Montgomery Asberg Depression Rating Scale (MADRS) score of ≥15. Depression response was the outcome variable, defined as a MADRS score of ≤10 for two consecutive assessments at the end of 12 weeks of open-label treatment with venlafaxine 300 mg/day. To assess OSA, participants were asked if they had been diagnosed with OSA using polysomnography.
Eighty participants (17.1%) reported a diagnosis of OSA prior to baseline. Participants with OSA were more likely to be male, report greater impairment on measures of health, experience a longer duration of the index episode, and receive an adequate antidepressant trial prior to entering the study. During the 12 weeks of treatment, 40.8% responded to treatment with venlafaxine (43.6%, n = 169/388 of the no OSA group, and 27.5%, n = 22/80 of the OSA group). Participants without OSA were 1.79 times more likely to respond to treatment (HR: 1.79 [95%CI: 1.13-2.86], P < .05) compared to those with OSA.
OSA may impair response to antidepressant pharmacotherapy in depressed older adults. Future studies of antidepressant response rates among depressed older adults with OSA should both prospectively diagnose OSA and monitor adherence to treatments such as continuous positive airway pressure.
阻塞性睡眠呼吸暂停（OSA）常与老年期抑郁症共病。本项目旨在以患有重度抑郁症的老年人群为样本，确定患者自述的OSA诊断是否与文拉法辛的反应率相关。
该多中心研究的参与者为年龄≥60岁（n = 468）的重度抑郁症患者，蒙哥马利-艾斯伯格抑郁量表（MADRS）得分≥15。抑郁反应为结果变量，定义为在接受300 mg/日文拉法辛开放标签治疗12周结束时，连续两次评估的MADRS得分≤10。为评估OSA，询问参与者是否曾通过多导睡眠图诊断为OSA。
80名参与者（17.1%）在基线前报告有OSA诊断。患有OSA的参与者更可能为男性，在健康指标上报告有更严重的损害，经历首发发作的持续时间更长，且在进入研究前接受过充分的抗抑郁试验。在12周的治疗期间，40.8%的患者对文拉法辛治疗有反应（无OSA组为43.6%，n = 169/388；OSA组为27.5%，n = 22/80）。与患有OSA的参与者相比，没有OSA的参与者对治疗有反应的可能性高1.79倍（HR：1.79 [95%CI：1.13 - 2.86]，P < .05）。
OSA可能会损害老年抑郁症患者对抗抑郁药物治疗的反应。未来关于患有OSA的老年抑郁症患者抗抑郁反应率的研究应前瞻性地诊断OSA，并监测对持续气道正压通气等治疗的依从性。
