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Sleep Disorders |

Depression in Moderate to Severe Obstructive Sleep Apnea

Karim El-Kersh, MD; Udit Chaddha, MD; Rodrigo Cavallazzi, MD; Juan Guardiola, MD; Mohamed Saad, MD
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University of Louisville, Louisville, KY


Chest. 2015;148(4_MeetingAbstracts):1044A. doi:10.1378/chest.2270063
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Abstract

SESSION TITLE: Sleep Disorders Posters I: Diagnosis

SESSION TYPE: Original Investigation Poster

PRESENTED ON: Wednesday, October 28, 2015 at 01:30 PM - 02:30 PM

PURPOSE: To examine the prevalence of depression in a cohort of patients with moderate to severe obstructive sleep apnea (OSA) and to investigate the relationship between depression and OSA.

METHODS: This was a retrospective study that included patients diagnosed with moderate to severe OSA [apnea-hypopnea index (AHI) ≥ 15] who underwent full attended polysomnography in University of Louisville Sleep Center over a period of two years (January 2013- January 2015). We performed chart review and abstracted data that included demographics, polysomnography (PSG) data, Epworth sleepiness scale and Patient Health Questionnaire (PHQ-9) reported on the initial evaluation visit before treatment of OSA. For statistical analysis Stata 10 (Stata Corp, College Station, Texas) was used and P value < 0.05 was considered statistically significant.

RESULTS: Two hundred patients with moderate to severe OSA were identified. Average age was 51.1 ± 12 years, 67.5% of the patients were females, and 22% were smokers. Average BMI was 40.12 ± 11.07, average Epworth sleepiness scale was 11.3 ±6, and average PHQ-9 was 10.3 ± 6.3. The prevalence of major depression (identified via a PHQ-9 score ≥ 10) was 50.5%. Average AHI was 53.5 ± 32.2. Using PHQ-9 cut-off score ≥10 to identify major depression, we divided the patients into 2 groups (Group 1: included 101 patients, likely with major depression, with PHQ-9 ≥10, and Group 2: included 99 patients, less likely with major depression, with PHQ-9 <10). On comparing the two groups, the group with PHQ- 9 score consistent with major depression (Group 1) had more females 40% vs. 25% (P= 0.03), higher BMI 42.6 ± 11.5 vs. 37.6 ±10.1 (P= 0.0015), higher AHI 58.8± 33.7 vs. 48 ± 29.7 (P= 0.0167), higher arousal index 44.5 ± 25 vs. 38.1 ± 17.8 (P= 0.038), higher initial Epworth sleepiness scale 12.5 ± 6.3 vs. 10.2 ±5.5 (P=0.0058), and higher number of smokers 32.7% vs. 11.1% (P <0.001).Using univariate logistic regression to predict depression, the odds ratio (OR) for AHI was 1.01 (95% CI, 1.002 to 1.02; P=0.018). After adjustment for BMI, the OR for AHI was 1.007 (95% CI, 0.99 - 1.02; P=0.176).

CONCLUSIONS: There is a high prevalence of depression in patients with moderate to severe OSA. The association between AHI and PHQ-9 score was not statistically significant after adjusting for BMI. Thus, Obesity may represent a link between OSA and depression.

CLINICAL IMPLICATIONS: Due to the high prevalence of depression in patients with moderate to severe OSA, depression screening is prudent in this patient population.

DISCLOSURE: The following authors have nothing to disclose: Karim El-Kersh, Udit Chaddha, Rodrigo Cavallazzi, Juan Guardiola, Mohamed Saad

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