Sleep Apnea; Depression and anxiety are public health challenges worldwide, contributing an enormous amount of human misery and lost health. Depression and anxiety commonly affect patients with chronic conditions, such as obstructive sleep apnoea (OSA) and cardiovascular (CV) disease, and they adversely impact on prognosis, quality of life and treatment adherence.
Obstructive sleep apnea
The relationship between abnormal mood and OSA is complex and bidirectional, with various potential pathophysiological mechanisms including sleep fragmentation, hypoxia, oxidative stress, inflammation and neurotransmitter imbalance. While continuous positive airway pressure (CPAP), the most widely use treatment for OSA, improves subjective symptoms such as daytime sleepiness, the effects specifically on depression and anxiety are uncertain.
Researchers have found that continuous positive airway pressure (CPAP) treatment of obstructive sleep apnea (OSA) can improve depression symptoms in patients suffering from cardiovascular diseases. Using data from the Sleep Apnea Cardiovascular Endpoints (SAVE) trial led by Flinders University; so the new study has found a significant decrease in cases of depression; hence after patients receive CPAP treatment for their sleep apnea.
This is by far the largest trial of its type and one of very few studies reporting such an effect; says Professor Doug McEvoy from Flinders University. From detail analysis of the SAVE data, Flinders University experts and collaborators; so at the George Institute have find that CPAP for moderate-severe OSA in patients with cardiovascular disease; so has broader benefits in terms of preventing depression, independent of improve sleepiness.
The heart attack
Prior studies investigating the effect of CPAP on mood with various experimental designs; also length of follow-up periods have yield heterogenous results. Patients who have had a stroke or heart attack are prone to suffer from low mood and are 2 to 3 times more likely to develop clinical depression, which then further elevates their risk of future heart attacks and strokes,” says SAVE principal investigator Professor McEvoy, a senior author in the paper just publish by The Lancet in EClinicalMedicine.
With up to 50% of patients with CV disease likely to have OSA; so the study is welcome news that treatment of OSA substantially relieves cardiovascular patients depressive symptoms and improves their well being. The paper’s first author, Dr Danni Zheng, from the George Institute for Global Health (UNSW); so says the 2687 OSA patients enroll in the SAVE trial were base solely on their history of cardiovascular disease and not on their current mood status.
After following them for an average of 3.7 years; so they find that CPAP provide significant reductions in depression symptoms; so compare with those who were not treat for OSA. The improvement for depression was apparent within six months and was sustained. As expect, those with lower mood scores to start with appear to get the greatest benefit.