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

Danni Zheng, Ying Xu, Shoujiang You, Maree L. Hackett, Richard J. Woodman, Qiang Li, Mark Woodward, Kelly A. Loffler, Anthony Rodgers, Luciano F. Drager, Geraldo Lorenzi-Filho, Xia Wang, Wei Wei Quan, Manjari Tripathi, Olga Mediano, Qiong Ou, Rui Chen, Zhihong Liu, Xilong Zhang, Yuanming LuoNigel McArdle, Sutapa Mukherjee, R. Douglas McEvoy, Craig S. Anderson

Research output: Contribution to journalReview article

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Abstract

Background: Whether continuous positive airway pressure (CPAP) treatment can improve depression or anxiety symptoms in obstructive sleep apnoea (OSA) patients remains uncertain. 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: 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: CPAP reduces depression symptoms in patients with co-existing OSA and CVD independently of improvements in sleepiness.

Original languageEnglish
Pages (from-to)89-96
Number of pages8
JournalEClinicalMedicine
Volume11
DOIs
Publication statusPublished - 13 Jun 2019

Bibliographical note

2589-5370/© 2019 Published by Elsevier Ltd. This is an open access article under the CC BY-NC-ND license

Keywords

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

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