Sleep Apnea Associated with Depression

Learn About Sleep Apnea Associated with Depression

Obstructive sleep apnea, a disorder of nocturnal ventilation in which the airway fully or partially collapses during sleep, is associated with various forms and levels of daytime impairment.  Among these are excessive daytime sleepiness, difficulty with concentration and memory, diminished physical and mental stamina, and treatment resistance of common medical conditions such as obesity, hypertension, and diabetes.  Less well known is the link between obstructive sleep apnea and depression.

Depression, a mental disorder characterized by depressed mood or pervasive loss of interest along with disturbed sleep, appetite, energy, and concentration, excessive guilt, preoccupation with death and other morbid themes, and even suicidal thinking, is not an uncommon mental illness, affecting 1 in 10 men and 1 in 4 women over the course of their lifetimes.  There are higher levels of depression amongst people with obstructive sleep apnea, and among depressives with obstructive sleep apnea, treatment resistance is more common, just as it is for the medical conditions cited above.  

 While symptoms of obstructive sleep apnea and depression overlap somewhat, the diagnosis of depression requires either depressed mood or a pervasive lack of interest (anhedonia), neither of which are part of the obstructive sleep apnea symptom cluster; therefore, the diagnosis of depression can be made even if the obstructive sleep apnea is causing or exacerbating some of the depression symptoms.  At any rate, the question at this point is not the nature of the link between obstructive sleep apnea and depression, but whether treating the obstructive sleep apnea will improve depressed mood.

When obstructive sleep apnea is present with depression, the foundation of therapy must be the treatment of the obstructive sleep apnea.  The reasons are threefold- first, untreated obstructive sleep apnea confers treatment resistance to the depression.  Second, drugs like benzodiazepines used to treat some kinds of depression (as when anxiety or agitation are prominent) can worsen obstructive sleep apnea by decreasing tone in those muscle groups responsible for maintaining airway patency during sleep.  Finally, antidepressants generally affect central nervous system levels of serotonin, a neurotransmitter playing a prominent role in respiratory drive.  There is evidence that treating obstructive sleep apnea improves mood in depressed patients; further, treatments that target residual daytime sedation in obstructive sleep apnea also improve mood in depressives.  In summary, treatment of obstructive sleep apnea and related phenomena such as excessive daytime sleepiness in depressed patients is at least permissive of a good clinical response to management of the depression, and may contribute positively to a good outcome.

Mark J. Woyshville MD

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