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CPAP reduces depressive symptoms in patients with sleep apnea, CVD

Continuous positive airway pressure treatment reduced depressive symptoms in patients with co-existing obstructive sleep apnea and cardiovascular disease, study findings showed.

“The relationship between abnormal mood and [obstructive sleep apnea (OSA)] is complex and bidirectional,” Danni Zheng, PhD, of the University of New South Wales, Sydney, and colleagues wrote in EClinicalMedicine. “While continuous positive airway pressure (CPAP), the most widely used treatment for OSA, improves subjective symptoms such as daytime sleepiness, the effects specifically on depression and anxiety are uncertain.”

To determine whether CPAP can improve depression or anxiety symptoms in OSA, researchers conducted a secondary analysis of the Sleep Apnea Cardiovascular Endpoints (SAVE) trial, and a systematic review of randomized evidence.

In the SAVE analyses, 2,410 patients with co-existing moderate-to-severe OSA and cardiovascular disorder were randomly allocated to receive CPAP treatments plus usual care or usual care alone, with follow-up for 3.7 years. The investigators measured patients’ change on the Hospital Anxiety and Depression Scale depression and anxiety subscales (HADS-D and HADS-A).

Zheng and colleagues found that CPAP treatment was linked to decreased depressive symptoms (OR = 0.8; 95% CI, 0.65-0.98) compared with usual care among patients with OSA and cardiovascular disorder in the SAVE trial, with a greater treatment effect among those with pre-existing symptoms. The effect of CPAP occurred within several months of starting treatment and were independent of improvements in daytime sleepiness.

Results from the systematic review, which yielded 20 randomized trials encompassing 4,255 participants, confirmed these findings and showed that CPAP reduced depression symptoms (standardized mean difference = –0.18; 95% CI, –0.24 to –0.12).

However, CPAP treatment did not improve anxiety symptoms for participants of the SAVE study (adjusted OR = 0.98; 95% CI, 0.78-1.24) or in the systematic review, according to the finding.

“Our findings provide further support for the broader beneficial effects of CPAP in those with OSA, and especially those at high [cardiovascular] risk, where there is the potential for enhanced mood to improve long-term [cardiovascular] outcomes,” Zheng and colleagues wrote. – by Savannah Demko

Disclosure: Zheng reports no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.