Comorbidity

Worsening Daytime Fatigue, Reduced Quality of Life Linked to Combined Sleep Apnea and Depression

Sydney, Australia – A new analysis of over 800 patients reveals that individuals suffering from both obstructive sleep apnea (OSA) and depression experience significantly worse daytime fatigue and diminished quality of life compared to those with OSA alone, even without detectable alterations in sleep structure. The findings, drawn from the Sydney Sleep Biobank database, underscore the importance of screening for co-occurring mental health conditions in sleep apnea patients to optimize treatment and improve patient outcomes.

Obstructive sleep apnea, a condition where breathing repeatedly stops and starts during sleep, and depression are both widespread health concerns individually impacting millions globally. while both are known to disrupt sleep and lower overall well-being, the combined effect of these conditions has been less understood. This study provides crucial insight into the specific challenges faced by individuals experiencing both OSA and depression,highlighting a critical need for integrated care approaches. The research suggests that even when sleep architecture appears similar, the subjective experience of sleep and it’s impact on daily functioning are substantially compromised.

Researchers assessed 821 participants (38% female, average age 49.5 years, standard deviation 15.6 years) referred for overnight sleep studies due to suspected sleep-disordered breathing. Participants were categorized into four groups based on their apnoea-hypopnoea index (AHI) – a measure of sleep apnea severity – and scores on the Depression Anxiety Stress Scale-21 (DASS-21). The groups were: those with neither OSA nor depression, those with OSA only, those with depression only, and those with both conditions (OSAD).

The study revealed that patients with comorbid OSAD and those with depression alone reported higher scores on the Epworth Sleepiness Scale (ESS) – indicating increased daytime sleepiness – (8.4 and 8.9 respectively) compared to those with OSA only (6.9,p=0.003). Furthermore, both groups exhibited significantly lower scores on the Functional Outcomes of Sleep Questionnaire-10 (FOSQ-10), a measure of sleep-related quality of life (13.9 and 12.8 respectively) compared to the OSA-only group (16.7, p<0.001).

Interestingly, after accounting for factors like age, gender, body mass index, alcohol consumption, and psychiatric medication use, and specifically excluding patients taking psychiatric medications, the researchers found no significant differences in sleep architecture between the OSAD group and those with OSA alone. This suggests the detrimental effects on daytime functioning are not driven by changes in the fundamental structure of sleep itself.

The authors conclude that identifying comorbid OSA and depression remains vital, despite the absence of observable changes in sleep architecture. The combination is demonstrably linked to a poorer quality of life, which, in turn, can negatively affect adherence to treatment plans. The study’s keywords include: Depression, DASS-21, Epworth sleepiness scale, FOSQ-10, Obstructive sleep apnoea, Polysomnogram, Quality of life, and Sleep architecture.