CPAP Provides Relief From Depression

Continuous positive airway pressure (CPAP) treatment provides relief from depression in those with obstructive sleep apnea (OSA). This is true irrespective of how well CPAP treatment improved sleep status. There was no significant decrease in anxiety symptoms in those receiving CPAP treatment.

These findings were reported in “Effects Of Continuous Positive Airway Pressure On Depression And Anxiety Symptoms In Patients With Obstructive Sleep Apnoea: Results From The Sleep Apnoea Cardiovascular Endpoint Randomised Trial And Meta-Analysis” by Danni Zheng, Ying Xu Shoujiang You, Maree L. Hackett, Richard J. Woodman, et al. The researchers conducted a secondary analysis of data from the international Sleep Apnea Cardiovascular Endpoints (SAVE) trial, combined with a systematic review of randomized evidence. The SAVE secondary analysis involved 2,410 individuals with co-existing moderate-to-severe OSA. Of this sample, 1,220 received CPAP treatment with “usual cardiovascular care;” while 1,190 received “usual cardiovascular care” only (no details of “usual depression/anxiety care” were offered in the study). Individuals in the study were followed up for three to seven years. The goal was to determine whether CPAP treatment can improve depression and anxiety symptoms in those with OSA.

For the analysis, Hospital Anxiety and Depression Scale scores for both depression (HADS-D) and anxiety (HADS-A) were used. The HADS is a 14-item scale containing several items related to anxiety and depression. Anxiety and depression symptoms were assessed at baseline, 6-months, and then annually until 84-months (or end of study, if that came first). For this study, HADS sub-scale scores ranging from 0 to 21 were classified as:

  • 0 to 7 = ‘non-case’ of depression or anxiety
  • 8 to 21 = ‘case’ of depression or anxiety

During the follow-up, the comparison between groups treated by CPAP and usual care demonstrated that both HADS-D and HADS-A scores decreased significantly with CPAP treatment. Reduction in cases with depression at six months was significant since the first assessment, and was sustained until 84 months. The decrease in cases with anxiety was also significant with CPAP treatment at six months but not evident at later assessments:

  • At the end of follow-up, 221 of individuals receiving both CPAP and “usual care” had a HADS-D score of at least 8, compared to 295 individuals receiving “usual care” only. This equated to a significant 33% odds reduction of depression for those receiving CPAP treatment on top of “usual care”.
  • At the end of follow-up, 176 individuals receiving CPAP and “usual care” had a HADS-A score of at least 8, compared to 202 individuals receiving “usual care” only. This equated to a non-significant 17% odds reduction of anxiety for those receiving both CPAP treatment on top of “usual care”.
  • The positive results from SAVE on the prevention of depression were confirmed in the meta-analysis.

The full text of “Effects Of Continuous Positive Airway Pressure On Depression And Anxiety Symptoms In Patients With Obstructive Sleep Apnoea: Results From The Sleep Apnoea Cardiovascular Endpoint Randomised Trial And Meta-Analysis” was published in the May-June 2019 issue of eClinical Medicine, published by The Lancet. An abstract is available online at https://www.sciencedirect.com/science/article/pii/S2589537019300902?via%3Dihub (accessed October 21, 2019).

For more information, contact: Craig S. Anderson, Professor of Neurology and Epidemiology, Faculty of Medicine, The George Institute for Global Health, Post Office Box M201, Missenden Road, Camperdown, New South Wales, Australia; 2050; Email: canderson@georgeinstitute.org.au; Website: https://www.georgeinstitute.org/people/craig-anderson

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