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Undetected OSA could hinder antidepressant response

W. Vaughn McCall

Researchers found that 14% of 125 suicidal adults with major depressive disorder, who were not suspected to have obstructive sleep apnea, actually did meet diagnostic criteria for the condition.

These findings indicated that undetected obstructive sleep apnea (OSA) could hinder a patient’s response to antidepressant treatment.

“Most patients with major depressive disorder don’t fully respond to the first-choice antidepressant that is prescribed, and many of those don’t subsequently respond fully to the second, or the third option either,” W. Vaughn McCall, MD, MS, Case Distinguished University Chair, department of psychiatry and health behavior, and executive vice dean, Medical College of Georgia, Augusta University, told Healio Psychiatry.

To estimate the rate of unsuspected OSA in suicidal patients with MDD, the researchers tested for OSA in a sample of 125 patients with insomnia who were believed to have a low pre-test probability for OSA. They also examined traditional risk factors for OSA like age, gender and BMI. Participants underwent either one night of home portable testing (n = 60; which measured airflow, respiratory effort and pulse oximetry) or one night of in-lab polysomnography (n = 65; which included EEG plus respiratory measures).

The results revealed that unsuspected, undetected OSA occurred at meaningful rates in major depressive disorder — in this study, at a rate of 14% (n = 17). Of these, four people with MDD had severe OSA. However, other studies have yielded rates of unsuspected OSA up to 17%, according to McCall.

Overall, 52 participants had failed at least one adequate trial of an antidepressant.

“The presence of OSA has been shown by other investigators to impede the response to antidepressants, while the treatment of OSA has been shown to improve depressive symptoms,” McCall said. “The novelty of our study is twofold: (1) we exclusively studied MDD-patients who were suicidal, and (2) we only studied patients whom were believed to not have OSA. So, our study shows that OSA occurs at meaningful rates even when you don’t have a clinical suspicion of it.”

Analysis indicated that only age was significantly linked to OSA diagnosis after adjusting for other covariates (OR = 1.06; 95% CI, 1-1.13). In addition, male sex, older age and greater BMI were linked to higher Apnea Hypopnea Index score after adjusting for other covariates.

“The take-home message for clinicians is this: if you have a depressed patient who has failed to get a good result after two or more antidepressant medication trials, then consider whether obstructive sleep apnea could be hindering the patient’s progress,” McCall told Healio Psychiatry. – by Savannah Demko

Disclosures: McCall reports honoraria from Anthem Inc., CME Outfitters and Wolters Kluwer Publishing; research support from Merck and MECTA Corp; and advising for Sage Therapeutics. Please see the study for all other authors’ relevant financial disclosures.