Effects of continuous positive airway pressure on depression and anxiety symptoms in patients with obstructive sleep apnoea: results from the sleep apnoea cardiovascular Endpoint randomised trial and meta-analysis.

Anxiety Cardiovascular diseases Continuous positive airway pressure Depression Mood OSA Obstructive sleep apnoea

Journal

EClinicalMedicine
ISSN: 2589-5370
Titre abrégé: EClinicalMedicine
Pays: England
ID NLM: 101733727

Informations de publication

Date de publication:
Historique:
received: 03 04 2019
revised: 23 05 2019
accepted: 28 05 2019
entrez: 18 7 2019
pubmed: 18 7 2019
medline: 18 7 2019
Statut: epublish

Résumé

Whether continuous positive airway pressure (CPAP) treatment can improve depression or anxiety symptoms in obstructive sleep apnoea (OSA) patients remains uncertain. Secondary analysis of the Sleep Apnea Cardiovascular Endpoints (SAVE) trial, combined with a systematic review of randomised evidence. The SAVE secondary analyses involved 2410 patients with co-existing moderate-severe OSA and established cardiovascular disease randomly allocated to CPAP treatment plus usual care or usual care alone and followed up for 3·7 (SD 1·6) years. We evaluated the effect of CPAP treatment on depression and anxiety caseness (scores ≥ 8 on the Hospital Anxiety and Depression Scale depression and anxiety subscales [HADS-D and HADS-A]) for OSA patients. CPAP treatment was associated with reduced odds of depression caseness (adjusted odds ratio [OR] 0·80, 95% confidence interval [CI] 0·65-0·98, P = 0·031) compared to usual care in the SAVE trial and the treatment effect was greater in those with pre-existing depression symptoms. A systematic review of 20 randomised trials including 4255 participants confirmed a benefit of CPAP in reducing depression symptoms in OSA patients: the overall effect (standardised mean difference) was - 0·18 (95% CI - 0·24 to - 0·12). No effect of CPAP treatment on anxiety caseness was found both in patients of the SAVE study (adjusted OR 0·98, 95% CI 0·78-1·24, P = 0·89) and the systematic review. CPAP reduces depression symptoms in patients with co-existing OSA and CVD independently of improvements in sleepiness.

Sections du résumé

BACKGROUND BACKGROUND
Whether continuous positive airway pressure (CPAP) treatment can improve depression or anxiety symptoms in obstructive sleep apnoea (OSA) patients remains uncertain.
METHODS METHODS
Secondary analysis of the Sleep Apnea Cardiovascular Endpoints (SAVE) trial, combined with a systematic review of randomised evidence. The SAVE secondary analyses involved 2410 patients with co-existing moderate-severe OSA and established cardiovascular disease randomly allocated to CPAP treatment plus usual care or usual care alone and followed up for 3·7 (SD 1·6) years. We evaluated the effect of CPAP treatment on depression and anxiety caseness (scores ≥ 8 on the Hospital Anxiety and Depression Scale depression and anxiety subscales [HADS-D and HADS-A]) for OSA patients.
FINDINGS RESULTS
CPAP treatment was associated with reduced odds of depression caseness (adjusted odds ratio [OR] 0·80, 95% confidence interval [CI] 0·65-0·98, P = 0·031) compared to usual care in the SAVE trial and the treatment effect was greater in those with pre-existing depression symptoms. A systematic review of 20 randomised trials including 4255 participants confirmed a benefit of CPAP in reducing depression symptoms in OSA patients: the overall effect (standardised mean difference) was - 0·18 (95% CI - 0·24 to - 0·12). No effect of CPAP treatment on anxiety caseness was found both in patients of the SAVE study (adjusted OR 0·98, 95% CI 0·78-1·24, P = 0·89) and the systematic review.
INTERPRETATION CONCLUSIONS
CPAP reduces depression symptoms in patients with co-existing OSA and CVD independently of improvements in sleepiness.

Identifiants

DOI: 10.1016/j.eclinm.2019.05.012 PMID: 31312807 PMC: PMC6610775
pubmed: 31312807
doi: 10.1016/j.eclinm.2019.05.012
pii: S2589-5370(19)30090-2
pmc: PMC6610775
doi:

Types de publication

Journal Article

Langues

eng

Pagination

89-96

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Auteurs

Danni Zheng (D)

Centre for Big Data Research in Health, University of New South Wales, Sydney, NSW, Australia.
The George Institute for Global Health, Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia.

Ying Xu (Y)

The George Institute for Global Health, Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia.
Sydney Medical School, University of Sydney, Sydney, NSW, Australia.

Shoujiang You (S)

Department of Neurology, The Second Affiliated Hospital of Soochow University, Suzhou, Jiangsu, PR China.

Maree L Hackett (ML)

The George Institute for Global Health, Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia.
Faculty of Health and Wellbeing, The University of Central Lancashire, Preston, Lancashire, UK.

Richard J Woodman (RJ)

Flinders Centre for Epidemiology and Biostatistics, College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia.

Qiang Li (Q)

The George Institute for Global Health, Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia.

Mark Woodward (M)

The George Institute for Global Health, Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia.
The George Institute for Global Health, University of Oxford, Oxford, Oxfordshire, UK.
Department of Epidemiology, Johns Hopkins University, Baltimore, MD, USA.

Kelly A Loffler (KA)

Adelaide Institute for Sleep Health, Flinders University, Adelaide, SA, Australia.

Anthony Rodgers (A)

The George Institute for Global Health, Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia.

Luciano F Drager (LF)

Hypertension Unit, Heart Institute (InCor), University of Sao Paulo Medical School, Sao Paulo, Brazil.
Hypertension Unit, Renal Division, University of Sao Paulo Medical School, Sao Paulo, Brazil.

Geraldo Lorenzi-Filho (G)

Sleep Laboratory, Pulmonary Division, University of Sao Paulo Medical School, Sao Paulo, Brazil.

Xia Wang (X)

The George Institute for Global Health, Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia.

Wei Wei Quan (WW)

Department of Cardiology, Rui Jin Hospital and Institute of Cardiovascular Diseases, Shanghai Jiao Tong University School of Medicine, Shanghai, PR China.

Manjari Tripathi (M)

Department of Neurology, All India Institute of Medical Sciences, Delhi, India.

Olga Mediano (O)

Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Madrid, Spain.
Respiratory Department, Hospital Universitario de Guadalajara, Universidad de Alcalá, Madrid, Spain.

Qiong Ou (Q)

Sleep Center, Respiratory and Critical Medical Department, Guangdong Institute of Geriatrics, Guangdong Academy of Medical Sciences, Guangdong Provincial People's Hospital, Guangzhou 510000, Guangdong PR, PR China.

Rui Chen (R)

The Second Affiliated Hospital of Soochow University, Suzhou, Jiangsu, PR China.

Zhihong Liu (Z)

Department of Cardiology, Fuwai Hospital, Beijing, PR China.

Xilong Zhang (X)

The First Affiliated Hospital of Nanjing Medical University, Nanjing, PR China.

Yuanming Luo (Y)

The First Affiliated Hospital of Guangzhou Medical University, State Key Laboratory of Respiratory Disease, Guangzhou, PR China.

Nigel McArdle (N)

West Australian Sleep Disorders Research Institute, Department of Pulmonary Physiology and Sleep Medicine, Sir Charles Gairdner Hospital, Nedlands, WA, Australia.

Sutapa Mukherjee (S)

Adelaide Institute for Sleep Health, Flinders University, Adelaide, SA, Australia.
West Australian Sleep Disorders Research Institute, Department of Pulmonary Physiology and Sleep Medicine, Sir Charles Gairdner Hospital, Nedlands, WA, Australia.
Sleep Health Service, Respiratory and Sleep Services, Southern Adelaide Local Health Network, Flinders Medical Centre, Adelaide, SA, Australia.

R Douglas McEvoy (RD)

Adelaide Institute for Sleep Health, Flinders University, Adelaide, SA, Australia.
Sleep Health Service, Respiratory and Sleep Services, Southern Adelaide Local Health Network, Flinders Medical Centre, Adelaide, SA, Australia.

Craig S Anderson (CS)

The George Institute for Global Health, Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia.
Neurology Department, Royal Prince Alfred Hospital, Sydney Health Partners, Sydney, NSW, Australia.
The George Institute for Global Health China at Peking University Health Science Center, Beijing, PR China.

Classifications MeSH