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Certain sleep disorders increase depression frequency, severity in men

Men with comorbid obstructive sleep apnea and insomnia symptoms have a greater likelihood and severity of depression than men with only one of these conditions, according to research recently published in Respirology.

Obstructive sleep apnea (OSA) and insomnia are the two most prevalent sleep disorders and often coexist in patients, according to researchers; comorbid insomnia and OSA is reported in 42% to 55% of OSA patients in primary care or sleep clinics.

“Previous studies characterizing the clinical profile of patients with comorbid OSA and insomnia in sleep clinic settings have been predominantly retrospective in their design and many of their findings are largely inconsistent... Consequently, issues of under diagnosis and misclassification remain problematic,” Carol J. Lang, PhD, The University of Adelaide, Australia, and colleagues wrote.

To gather more data, researchers asked 700 men in Australia without a previous OSA diagnosis to complete full at-home unattended polysomnography, the Pittsburgh Sleep Quality Index and 36-item short form survey. Insomnia symptoms included difficulty initiating/maintaining sleep in the presence of daytime fatigue. Depression symptoms were evaluated using the Beck Depression Inventory-1A, Centre for Epidemiological Studies Depression Scale and Patient Health Questionnaire-9. The mean age of the participants was 58.5 years.

Lang and colleagues found that the prevalence of comorbid obstructive sleep apnea among participants was 6.7%. In addition, depression prevalence and severity scores were highest in the men showing symptoms of co-morbid obstructive sleep apnea and insomnia as opposed to those showing symptoms of OSA or daytime fatigue alone. In addition, mean scores were 16.1 for the Patient Health Questionnaire-9; 14 for difficulty initiating/maintaining sleep in the presence of daytime fatigue; and 11.4 for OSA. Researchers also found that for patients with comorbid OSA and insomnia symptoms, respiratory and arousal indices were similar to those observed in OSA, and the reductions in subjective sleep and day dysfunction scores were similar to difficulty initiating/maintaining sleep in the presence of daytime fatigue.

“[These results are] likely to affect decisions as to how best to reach and identify these men in the community in order to encourage them to seek medical advice for their comorbid condition as well as treatment strategies for their conditions once diagnosed,” Lang and colleagues wrote.

“Furthermore, recognition by primary [caregivers] that [comorbid] OSA and insomnia symptoms is more common than [difficulty initiating/maintaining sleep in the presence of daytime fatigue] alone and is strongly associated with particularly poor mental health outcomes warrants improved clinical investigation to avoid potentially counterproductive hypnotic medication prescription in many men.” – by Janel Miller

Disclosure: Lang reports no relevant financial disclosures. Please see the study for a list of the other authors’ relevant financial disclosures.