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Treatment for obstructive sleep apnea modestly improved depression
Patients with obstructive sleep apnea who were treated with continuous positive airway pressure or mandibular advancement devices showed modest improvement for depression, according to a new meta-analysis.
Researchers identified 24 random, controlled trials of obstructive sleep apnea (OSA) patients with prevalence of depression at baseline. Nineteen of the trials treated participants with continuous positive airway pressure (CPAP), three with mandibular advancement devices (MAD) and two with both devices. Six studies excluded participants taking antidepressants; one excluded those taking benzodiazepines, and the remaining studies did not report the use or exclusion of medications. None of the studies included the initiation of treatment with antidepressants after baseline.
The mean age of the participants (n=1,355) ranged from 42 to 78 years, the proportion of men ranged from 46% to 100%, and the mean BMI ranged from 24.7 kg/m2 to 42.5 kg/mg2. Depressive symptoms were measured using the Beck Depression Inventory, the Brief Symptom Inventory and other standard questionnaires. Control participants were mostly given sham devices.
Treatment with CPAP devices resulted in improved depressive symptoms (standardized mean difference=0.312; 95% CI, 0.099-0.525) vs. controls, but variability was present (I2=71.3%; 95% CI, 54%-82%). Those treated with MAD showed significant improvement compared with controls (SMD=0.214; 95% CI, 0.026-0.401), with no significant heterogeneity.
“Our study provides new information on the efficacy of CPAP and MADs for treatment of depressive symptoms in OSA, including results from 11 trials published since the last systematic review of OSA treatment and resolving the unexplained variability in treatment effect reported in the prior systematic review,” the researchers wrote. “Both CPAP and MAD treatment result in small improvements in depressive symptoms based on questionnaires. Additional high-quality [random-controlled trials] would be helpful.”
Disclosure: The researchers report no relevant financial disclosures.