Sleep apnea and depression pdf
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- Awakening to the dangers of obstructive sleep apnea
- Increased risk of major depressive disorder in sleep apnea patients in Taiwan
- NEJM Journal Watch
- The Relationship Between Sleep Apnea and Mental Health
Awakening to the dangers of obstructive sleep apnea
Imran S. OSA, as well as other sleep disorders, often co-exists with mental illness. Optimal care involves treating the 2 problems concurrently. Estimates are that 50 to 70 million Americans suffer from a chronic disorder of sleep and wakefulness, hindering daily functioning and affecting health. The relationship between psychiatric illness and sleep disorders is bidirectional: People with mental illness often have sleep complaints, and a primary sleep disorder often results in neuropsychiatric complications.
The most common type of sleep-disordered breathing, obstructive sleep apnea OSA is characterized by frequent cessations of breathing during sleep because of an obstruction of the upper airway. The obstruction occurs secondary to inadequate motor tone of the tongue or airway dilator muscles, or both. Risk factors for OSA include obesity, a craniofacial abnormality, an upper-airway abnormality, heredity, smoking, and nasal congestion.
OSA plays a role in causing and exacerbating medical illness in people with severe and persistent mental illness, contributing to a significantly shortened life span. Attending to the general health of people who suffer from severe mental illness—including effective treatment of illnesses such as OSA—is crucial. OSA is characterized by hypopnea a decrease in breathing during sleep or apnea an actual pause in breathing.
Pauses in breathing during sleep of at least 10 seconds, with obstruction of oronasal airflow despite continuous chest and abdominal movements, are referred to as obstructive apneas. These pauses are associated with a decrease in oxygen saturation or arousal from sleep, or both.
Primary features of OSA include sleep fragmentation accompanied by nocturnal hypoxemia and hypercapnia, with resulting excessive daytime sleepiness, mood problems, and poor neurocognitive performance Table 1. OSA often causes potentially serious organ system dysfunction, including adverse cardiovascular and metabolic effects.
Studies have suggested that executive dysfunction can be a feature of OSA, which is thought to be related to prefrontal lobe dysfunction caused by intermittent hypoxia.
All of these conditions can contribute significantly to decreased quality of life. The index is the number of apnea and hypopnea episodes that occur during 1 hour of sleep. Psychiatric disorders often are comorbid with OSA. These include depression, anxiety, bipolar disorder, schizophrenia, posttraumatic stress disorder PTSD , panic disorder, and substance use disorder.
Several studies have documented that OSA and depressive disorder often are comorbid. Many symptoms are common to both, including fatigue, daytime sleepiness, poor concentration, irritability, and weight gain Figure , although some core symptoms of depression eg, sadness, anhedonia, guilt, and agitation are clearly distinguishable from symptoms of OSA.
The current recommendation is that a mood disorder should be considered secondary to OSA, and treated accordingly. OSA also has been linked to anxiety and nocturnal panic attacks. Frequent awakening due to choking from breathing cessation might play a role in the development of anxiety in patients with OSA, although the association is unproven. Studies have shown a correlation between anxiety disorders and excessive daytime sleepiness, one of the core symptoms of OSA.
A strong association exists between OSA and schizophrenia. In a study, 9 an OSA diagnosis was made 6 times more often in patients with schizophrenia than in patients with other psychiatric illnesses.
Obesity, male sex, and chronic antipsychotic administration were risk factors for OSA in patients with schizophrenia. OSA can be comorbid with several medical conditions Table 2. Sleep research in the past 15 years has demonstrated that chronic sleep deprivation has multiple untoward health consequences apart from excessive daytime sleepiness.
Skip to main content. Evidence-Based Reviews. Awakening to the dangers of obstructive sleep apnea. Current Psychiatry. Khawaja, MD. PDF Download. What is obstructive sleep apnea? Read More.
Increased risk of major depressive disorder in sleep apnea patients in Taiwan
Obstructive sleep apnea OSA is a widely prevalent sleep-related breathing disorder, which leads to several life-threatening diseases. OSA has systemic effects on various organ systems. Untreated OSA is associated with long-term health consequences including hypertension, heart disease, diabetes, depression, metabolic disorders, and stroke. In addition, untreated OSA is reported to be associated with cognitive dysfunction, impaired productivity at the workplace and in an increased risk of motor vehicle accidents MVAs resulting in injury and fatality. Other consequences of OSA include, but are not limited to, impaired vigilance, daytime somnolence, performance deficits, morning headaches, mood disturbances, neurobehavioral impairments, and general malaise. Additionally, OSA has become an economic burden on most health systems all over the world.
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NEJM Journal Watch
Metrics details. For over two decades clinical studies have been conducted which suggest the existence of a relationship between depression and Obstructive Sleep Apnea OSA. In clinical practice, the presence of depressive symptomatology is often considered in patients with OSA, and may be accounted for and followed-up when considering treatment approaches and response to treatment. On the other hand, sleep problems and specifically OSA are rarely assessed on a regular basis in patients with a depressive disorder. However, OSA might not only be associated with a depressive syndrome, but its presence may also be responsible for failure to respond to appropriate pharmacological treatment.
Continuous positive airway pressure treatment was associated with significantly improved depression in patients with established cardiovascular disease. Depression and anxiety, both as symptoms and as formal disorders, are elevated in patients with chronic medical disorders, including obstructive sleep apnea, for which continuous positive airway pressure CPAP treatment is the standard of care. To study the relationship of CPAP to depressive and anxiety symptoms, investigators performed a secondary analysis of data from an international, randomized, controlled, prospective study examining the effectiveness of CPAP treatment for secondary prevention of cardiovascular disease in participants baseline mean age, 61; mean body-mass index, At follow-up mean, 3.
Participants were 39 outpatients 35 males, 4 females with no current or past mental health problems, diagnosed with OSA in a hospital sleep disorders clinic. Our findings suggest that depressive symptoms experienced by OSA patients are not solely the result of physical OSA symptoms but include a mood component as well. We introduce a hypothetical model to conceptualize the relationship between OSA and depression.
The Relationship Between Sleep Apnea and Mental Health
Continuous positive airway pressure treatment was associated with significantly improved depression in patients with established cardiovascular disease. Depression and anxiety, both as symptoms and as formal disorders, are elevated in patients with chronic medical disorders, including obstructive sleep apnea, for which continuous positive airway pressure CPAP treatment is the standard of care. To study the relationship of CPAP to depressive and anxiety symptoms, investigators performed a secondary analysis of data from an international, randomized, controlled, prospective study examining the effectiveness of CPAP treatment for secondary prevention of cardiovascular disease in participants baseline mean age, 61; mean body-mass index, At follow-up mean, 3. No group differences were seen in anxiety.
Sesso, D. Last month we learned about the significant link between obstructive sleep apnea OSA and diabetes and obesity. A quick recap of OSA Obstructive sleep apnea occurs due to a collapse of the upper airway during sleep, restricting breathing and reducing oxygen intake during recurrent episodes of apnea. Unfortunately, the same study also found these patients with OSA reported a greater lack of mental healthcare and support. Multiple studies recognize the correlation between OSA and poor mood, post-traumatic stress disorder, and a higher prevalence of psychosis and schizophrenia. To further complicate the link between schizophrenia and OSA, smoking and alcohol consumption is thought to confer an increased risk of sleep apnea, and these two behaviors are also highly common in those with schizophrenia. More research is required on the association between OSA and bipolar disorder but existing studies note the prevalence of OSA in bipolar patients to be similar in schizophrenics.