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 “It’s thought that sleep apnea could contribute to depression
through its effects on sleep quality as sleep fragmentation occurs
from the frequent apnea events, but this hasn't been proven
experimentally,” said lead author Dr. Marcus Povitz of Western
University in London, Ontario, Canada.
“Also there is a hypothesis that the dips in oxygen due to the
apneas might cause injury to the brain which could lead to
depression,” Povitz told Reuters Health by email.
Obstructive sleep apnea (OSA) includes repeated upper airway
obstruction during sleep - often due to the jaw sinking into the
throat, closing off the airway – and, as a result, frequent waking
and oxygen deprivation
The problem has been linked to insomnia, poor memory and
irritability as well as increased mortality and decreased quality of
life, the authors write.
It may be caused by other health problems like congestive heart
failure, but if not, it can be treated with gentle air pressure
administered during sleep with a continuous positive airway pressure
(CPAP) device, according to the Centers for Disease Control and
Prevention.
For the review, the authors included randomized controlled trials of
patients using CPAP devices or a mandibular advancement device
(MAD), an alternative which holds the lower jaw and tongue forward
during sleep.
They included 19 trials with CPAP machines, three with MADs, and two
with both devices.
There was a wide range of study designs, but using CPAP devices did
tend to improve depression symptoms compared to no apnea treatment,
and improved symptoms more if patients were more depressed at the
start.
Treatment with MADs also improved depression symptoms compared to no
treatment, according to the results published in PLoS Medicine.
Anecdotally, many sleep physicians have reported dramatic
improvements in patient mood following sleep apnea treatment, Povitz
said, but the benefits they found in the new review were small, so
more studies are needed to determine who will benefit the most.
“Approximately 6 percent of adult U.S. men and 3 percent of adult
U.S. women have been told they had sleep apnea by a doctor or other
health professional,” said Dr. Anne Wheaton of the CDC, who was not
part of the new study.
Five percent of adults may have undiagnosed obstructive sleep apnea
syndrome with daytime sleepiness, and up to 20 percent have at least
mild OSA, she told Reuters Health by email.
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“It has been recognized for a long time that sleep apnea and
depression often coexist in the same patient, but nobody really
knows the reason,” said Dr. Richard Leung, assistant professor at
the University of Toronto, who also was not part of the new study.
Sleep problems may be caused by depression or vice versa, he told
Reuters Health by email. Sleep apnea could also lead to symptoms
that are similar to, and mistaken for, depression, he noted.
“I have treated sleep apnea in patients with depression in my
practice,” Leung said.
“Following treatment, when they are feeling better, some choose to
think of it as, ‘My depression got better when my sleep apnea got
treated’,” he said. “Others choose to frame it as, ‘I never had
depression at all. It was always sleep apnea.’ I don't know which of
them is right.”
The new review indicates that sleep apnea may at least partially
contribute to the development or worsening of depression, Wheaton
said.
“Feeling excessively sleepy or tired is in and of itself a symptom
of depression,” Wheaton said. “If treating sleep apnea improves
sleepiness, that is already a benefit.”
Sleep apnea also increases the risk of high blood pressure, diabetes
and cardiovascular disease. Post menopausal women and people who are
obese are at higher risk for sleep apnea, she said.
Dr. Karim Ghobrial-Sedky, associate professor of psychiatry at
Cooper Medical School of Rowan University in Camden, New Jersey,
recently had a patient with hypertension resistant to treatment, and
after screening for and treating severe obstructive sleep apnea, the
person’s blood pressure was better controlled.
“Educating physicians and patients to recognize this disorder is
important,” Ghobrial-Sedky told Reuters Health by email.
“Exploring different methods to decide on the most appropriate
treatment for each individual is important,” he said. “Emphasizing
the risks of not treating the disorder for patients is also
essential.”
SOURCE: http://bit.ly/15xXYOA PLoS Medicine, online November 25,
2014.
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