1 / 65

OSA AS A CAUSE OF DEPRESSION

OSA AS A CAUSE OF DEPRESSION. Oya İTİL Dokuz Eylül Medical Faculty Dept.of Pulmonary Medicine İZMİR. OSAS. OSAS is a syndrome characterized by repetitive upper airway obstructions and frequent oxygen desaturations during sleep.

leiko
Download Presentation

OSA AS A CAUSE OF DEPRESSION

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. OSA AS A CAUSE OF DEPRESSION Oya İTİL Dokuz Eylül Medical Faculty Dept.of Pulmonary Medicine İZMİR

  2. OSAS • OSAS is a syndrome characterized by repetitive upper airway obstructions and frequent oxygen desaturations during sleep.

  3. Symptoms affecting daily activities • Excessive daytime sleepiness • Neuropsychological symptoms • Irritability • Inability to concentrate • Cognitive disorder • Depressive symptoms • Other psychological disorders (somatisation,obsession-compulsion,hostility,nocturnal panic attacks,psychotic episodes

  4. OSA, may easily mimic the symptoms of a major depressive episode.

  5. Depression is the most common mood disorder in OSAS.

  6. Pathophysiology • Is it a primary consequence of OSAS? • Does it develop secondary to OSAS – related symptoms? • Sleepiness • Sleep problems • Irritability • Social problems • Is it associated with other OSAS – related factors ? • Obesity • Hypertension

  7. Sleep structure in OSA and depression • Major depression • PSG increase in sleep latency frequent nocturnal awakenings early morning awakenings decrease in deep sleep shortened REM latency increase in the ratio of REM

  8. OSA • Fragmented sleep • Increase in initial sleep stages • Increase in REM latency

  9. OSA + depression decrease in sleep latency ( compared with cases without OSA, but with depression) • OSA + depression Increase in REM ratio (compared with cases with OSA, but without depression) Bardwell WA. Biol Psychiatry 2000; 48:1001-9

  10. Possible mechanisms of the association between OSA and depression • Two factors considered to be responsible of depressive symptoms in OSA : • Sleep fragmentation • Oxygen desaturation in sleep

  11. Microarousals related with apneas and hypopneas sleep fragmentation primary cause of excessive daytime sleepiness depressive symptoms • Intermittant oxygen desaturations caused by respiratory events nocturnal hypoxemia

  12. 44 cases ( OSA ) • Excessive daytime sleepiness • ESS ve MWT results are correlated with high depression scores. Sforza E. Sleep Med 2002;3:139-45

  13. The impact of cognitive disorder in OSA is correlated with the severity of the hypoxic events. • OSA – related hypoxemia affects the mood. Engleman HM, Sleep 2000;23 Suppl 4:5102-8 Kamba M. Am J Respir Crit Care Med 1997;156:296-98

  14. Recurrent nocturnal hypoxemia cerebral metabolic disorder McGown AD. Sleep 2003;26:710-716

  15. Increase in the intensity of brain white matter is associated with depressive symptoms • This increase is more significant in severe cases with OSA compared with milder cases. Sassi RB.J Affect Diord 2003; 77: 237-45 Firbank MJ. Am J Geriatr Psychiatry 2004;12:606-12 Aloia MS. J Int Neuropsychol Soc 2004;10:772-85

  16. A common neurobiological risk factor can be present in both disorders. • Serotoninergic system • Mood disorder • Sleep-wake cyclus • Upper airway muscle tone control in sleep

  17. Functional decrease in serotoninergic neurotransmission is associated with depression Adrien J. Sleep Med rev 2002;6:341-51

  18. Transmission of serotonin to upper airway motor neurons is diminished during wakefulness dilator muscle activity is primarily decreased during sleep uyku apne

  19. SSRI • Antidepressant effect • Fluoxetine, protryptiline, paroxetine

  20. Common risk factors • OSA - related obesity, HT and DM should raise the suspicion of comorbid or underlying OSA in a depressive patient. • Depression and OSA have been shown to be independently related with metabolic syndrome and cardiovascular disease. Gami AS. Eur Heart J 2004;25:709-11 Lett HS. Psychosom Med 2004;66:305-15

  21. Insulin resistance is a contributing factor in the relation between depression and cardiovascular disease and in the pathophysiology of depressive disorder. • OSA is also independently related with cardiovascular risk factors compassing metabolic syndrome, primarily insulin resistance. Coughlin SR. Eur Heart J 2004;25:735-41 Wilcox I. Thorax 1998;53 Suppl 3:S25-8

  22. Since there is a complex relationship between OSAS and depression , current recommendation is as follows: • Mood disorder should be considered as secondary to the medical condition, but not a different psychiatric entity.

  23. Prevalence • 24-25 % of male OSAS patients has administered to a psychiatrist before because of anxiety or depression. Guilleminault C. Arch Intern Med 1977;137:296-300 • In 40 % of 25 male OSA patients depression risk was found to be increased in cases with excessive daytime sleepiness when investigated for affective disorder. Reynolds CF.J Clin Psychiatry 1984;45:287-90

  24. 26 % depressive symptoms • 58 % major depression ( according to DSM-lll criteriae ) Mosko S. J Clin Psychol 1989;45:51-60 • Depression scores are two-fold higher in OSA cases than primary snorers Aikens JE. Sleep 1999;22:355-59

  25. Epidemiologic study • UK, Germany, Italy, Portugal and Spain • 18,980 patients • In 17 % of patients with sleep-disordered breathing major depression (+) Ohayon MM. J Clin Psychiatry 2003;64:1195-200;quiz,1274-6

  26. Early reviews related with OSAS and mood alterations are not systematic Andrews JG. Clin Psychol Rev 2004;24:1031-49 El-Ad B.Int Rev Psychiatry 2005;17:277-82 Sateia MJ. Clin Chest Med 2003;24:249-59 • Recent research findings • January 1995-June 2006 • 55 manuscripts SaunamakiT. Acta Neurol Scand 2007 ;116:277-88

  27. Number of cases: 8-1635 • 44-69 age • Male : 13-100 % Median:83%

  28. Depression prevalence 7-63 % • Mild in the majority • Prevalence of anxiety 11-70 %

  29. No significant difference in depressive symptoms in older cases with mild OSA ( AHİ > 5 ), in comparison with the control group ( AHİ < 5 ) in 5-years follow up. Phillips BA. Chest 1996;110:654-658 • 2271 , mostly male, with OSA • No relation between respiratory disorders and depression score (Symptom Check List 90 ) Pillar G. Chest 1998;114:697-703

  30. Depressive symptoms are more common in women Smith R. Chest 2002;121:164-72 Shepertycky MR. Sleep 2005;28:309-14 Pillar G. Chest 1998;114:697-703 Quintana –Gallego E. Respir Med 2004;98:984-9

  31. Relation between the severity of OSAS and depression • Heterogenous patient groups • No correlation was detected in a few studies including homogenous patient groups • Even in studies including mild OSAS cases prevalence of depression is 16-41 % Engleman HE. Am J Respir Crit Care Med 1999;159:461-7 Barnes M. Am J Respir Crit Care Med 2002;165:773-80

  32. The severity of depression is more correlated with excessive daytime sleepiness than hypoxemia.

  33. Zung Self-Rating Depression Scale • In 45 % of the patients depressive symptoms • Depression scores are higher in patients with high AHI Millman RP. J Clin Psychiatry 1989;50:348-51

  34. 204 cases ( 101 female, 103 male ) • Anxiety and depression scores negatively correlated with OSAS severity Fidan F. Toraks Dergisi 2006;7(2):125-29

  35. 56 cases • Long duration of symptoms in OSAS ( > 5 years ) increases the frequency of anxiety and depression. Şahbaz S. ERS Congress 2006

  36. CLINICAL ASSESSMENT • Primary attention is required in the evaluation of mood disorders. • Some of the methods may actually reflect sleep quality or daytime sleepiness , not the mood.

  37. Personal sleep history • ESS, FOSQ • Atypical OSA clinic ( in women ) • Irritability • Fatigue • Fragmented sleep • Inability to concentrate • General decrease in psychomotor performance

  38. In a depressive case, presence of sleep-wake complaints and the beginning of these complaints before the development of depressive psychopathology should be considered as underlying or comorbid OSA.

  39. Comorbid disorders related with OSA should also be carefully evaluated. • When antihypertansive or antidepressant drugs are recommended, possibility of OSA should be investigated. • Depressive patients suspected of OSA, should be referred to sleep centers for PSG.

  40. Patients with OSA should be systematically evaluated for depressive symptoms with standardized questionnaire forms in sleep centers. • However, since these questionnaires are not arranged specifically for the evaluation of depression in patients with OSA, they may not be appropriate in this group.

  41. Typically, if symptoms of severe depressive patients are not improved with OSA treatment, or their fatigue continues, they should be referred to a psychiatrist.

  42. 25 cases • 25 controls • Anxiety, somatization and sleepiness are high • Positive behaviour towards getting psychologic help. Ateş N.Akciğer Arşivi 2006

  43. TREATMENT

  44. 2 months CPAP treatment • 7 cases • Significant drop in Total Mood Disturbance score • Increase in slow wave sleep Derderian SS. Chest 1988;94:1023-27

  45. 4 weeks CPAP treatment • Improvement in mood and cognitive evaluation scores in mild- moderate OSAS patients. Engleman HM. Lancet 1994;343:572-75 Engleman HM. Thorax 1997;52:114-19

  46. 1-3 months CPAP treatment • Drop in depression scores Sanchez Al. Psychiatry Clin Neurasci 2001;55:641-646 Ramos Platon MJ. Int J Neurosci 1992;62:173-195 • CPAP therapy, decreases daytime sleepiness along with depressive symptoms in patients with OSA. McMahon JP. Wmj 2003;102:36-43

  47. Patients with OSAS with high anxiety and depression scores improve with CPAP therapy. Fidan F. Tüberküloz ve Toraks Dergisi 2007;55(3):271-77 • In severe OSAS patients, nasal CPAP improves quality of life decreasing depression. Kawahara S. Internal Medicine 2005;44:422-27 Akashiba T. Chest 2002;122:861-65

  48. No decrease in depression scores after 3-12 months CPAP treatment in severe OSAS cases Borak J. J Sleep Res 1996; 5:123-27 Munoz A. Eur Respir J 2000; 15:676-81 Henke KG. Am J Respir Crit Care Med 2001;163:911-17

More Related