Association between sleep apnea severity and symptoms of depression and anxiety among individuals with obstructive sleep apnea

Abstract

Objective: We determined whether the severity of sleep apnea is associated with symptoms of depression and anxiety in patients with obstructive sleep apnea (OSA) and whether symptoms of OSA, other than respiratory events, are associated with depression and anxiety symptoms.

Methods: Depressive and anxiety symptoms were defined as a Patient Health Questionnaire-9 score of ≥10 and a Generalized Anxiety Disorder-7 score of ≥8, respectively. Sleep apnea severity and rapid eye movement-related OSA were evaluated using the apnea-hypopnea index (AHI). Subjective symptoms of OSA were assessed using the Sleep Apnea Severity Questionnaire (SASQ). We conducted multivariate logistic regression analyses.

Results: We included 1390 adult patients with OSA (80.4% men) and 125 control subjects with primary snoring. Symptoms of depression and anxiety were present in 15.5% and 14.4% of patients with OSA, respectively. The prevalence of depressive and anxiety symptoms did not differ between OSA and control subjects after controlling for age and sex. Severe OSA, defined as an AHI score of ≥30, was significantly less likely than mild OSA to be associated with the presence of depression and anxiety symptoms in both the unadjusted and adjusted models (models were adjusted by age, sex, medical comorbidities, history of psychiatric disorders, and daytime sleepiness). By contrast, OSA symptoms assessed using the SASQ were positively correlated with the presence of depression and anxiety symptoms in both the unadjusted and adjusted models. Specifically, nocturnal awakening and morning waking symptoms, but not nocturnal breathing difficulties, were positively correlated with the presence of depression and anxiety symptoms. Subjects with rapid eye movement-related OSA were more likely to have depressive symptoms, but not anxiety, than those without.

Conclusions: Symptoms of depression and anxiety were negatively correlated with the severity of sleep apnea but positively correlated with nocturnal awakening and early morning symptoms of OSA.