Antidepressant use may exacerbate sleep breathing disruptions

Mysa Saad

The use of antidepressants, specifically serotonergic agents, may worsen sleep-related breathing disturbances in individuals with depression, according to findings presented at SLEEP 2018, the Annual Meeting of the Associated Professional Sleep Societies.

“Despite the involvement of the serotonergic system in respiratory functions, the effects of selective serotonin reuptake inhibitors (SSRIs) on sleep apnea in people with depression had not yet been investigated,” Mysa Saad, of the department of cellular and molecular medicine at the University of Ottawa, Ontario, Canada, and the Royal Institute of Mental Health Research, told Healio Internal Medicine. “In this study, we found worse levels of sleep-related breathing disruptions in individuals with depression who were using SSRIs, as compared to nonmedicated individuals with depression. Conversely, no such effect was found for those using nonserotonergic antidepressants (ie, norepinephrine-dopamine reuptake inhibitors), suggesting that sleep-related breathing disruptions possibly linked to antidepressants may operate via the serotonin system.”

Researchers screened a polysomnography database from the Royal Ottawa Mental Health Centre Sleep Disorders Clinic to identify individuals with a documented history of unipolar depressive syndrome, current depressive symptoms of at least mild severity — defined as having a score of at least 14 on the Beck Depression Inventory-II (BDI-II) — and no history of bipolar disorder, psychotic disorder, PTSD or neurocognitive disorder. After identifying 245 individuals meeting this criteria, researchers then divided participants into one of three groups based on antidepressant use at the time of their polysomnography: the serotonergic medication group (SSRI group; n = 89; 70% women; mean age, 45 years; mean BDI-II score, 23), the nonserotonergic medication group (NDRI group; n = 21; 57% women; mean age, 40 years; mean BDI-II score, 28) or the no psychotropic medication group (n = 135; 64% women; mean age, 44 years, mean BDI-II score, 21). Researchers compared measures of respiratory function during asleep across the three groups, looking specifically at apnea-hypopnea index and lowest percentage of blood oxygen saturation.

After controlling for severity of depression, researchers found that participants in the SSRI group had a higher apnea-hypopnea index score than those who were taking no medication (P = .015). In addition, the SSRI group had a lower percentage of blood oxygen saturation than either the no medication group (P = .02) or the NDRI group (P = .034).

“While these findings point towards an unsuspected side effect of one of the most commonly used medications, longitudinal studies are required to ascertain whether serotonergic antidepressants play a causal role in the emergence of respiratory disruptions during sleep,” Saad said. “Considering the adverse effects of sleep apnea on both physical and mental health, this would have important implications for the clinical management of depression, not only to limit the adverse impacts of breathing disorders on cardiovascular and metabolic health, but also to avoid preventable worsening in depressive symptomatology.” – by Melissa J. Webb

Reference:

Saad M, et al. Antidepressant use is linked to worse sleep-related breathing disturbances in people with depressive symptoms. Presented at: SLEEP 2018, the Annual Meeting of the Associated Professional Sleep Societies; June 2-6; Baltimore.

Disclosures: Healio Internal Medicine was unable to confirm relevant financial disclosures prior to publication.