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Coincidence of Insomnia and Depressive Disorders Play Significant Role on Acceptance to Continuous Positive Airway Pressure Therapy in Patients with Severe Obstructive Sleep Apnea
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A4893 - Coincidence of Insomnia and Depressive Disorders Play Significant Role on Acceptance to Continuous Positive Airway Pressure Therapy in Patients with Severe Obstructive Sleep Apnea
Author Block: S. Tryfon1, T. Drakou2, M. Saroglou3, D. Kazis4, S. Papagiannopoulos5, P. A. Steiropoulos2; 1Pulmonary Clinic NHS General Hosp., Thessaloniki, Greece, 2Dimocritio Univ Thrace, General Hosp, Alexandroupoli, Greece, 3Pulmonary Dpt NHS, General Hosp., Drama, Greece, 4Neurology Clinic Aristotle University General Hosp., Thessaloniki, Greece, 5Neurology Clinic Aristotle Univ General Hosp., Thessaloniki, Greece.
Background and Objective Co-morbid insomnia with 39-58% of sleep apnea patients reduces the initial acceptance of continuous positive airway pressure (CPAP) therapy for Obstructive Sleep Apnea (OSA). The prevalence of depressive disorders (DD) in patients with OSA ranges from 5 to 63%. DD reported is of variable severity, diagnosed by clinical questionnaires or on the basis of the patient’s self-reported symptoms. Our work aims to examining the relationships between co-occurring DD and insomnia with OSA, and discuss treatment acceptance in a real life controlled trial. Methods All of 259 participants [72,4% men, mean age 52,91±13 years, (18-85 years) and body mass index (BMI)= 33,63±7,24kg/m2] who visited our lab in a year period, for sleep breathing disorders were included. Before the participants underwent for a polysomnography study they completed a battery of questionnaires; Epworth Sleepiness Scale (ESS), Short Form-36 Health Survey (SF-36), Berlin Questionairre (BQ), Athens Insomnia Scale (AIS), and ZUNG Self-Rating Depression Scale (ZDRS). The participants separated in 4 groups; no OSA (group A: n=56), mild (B: n=47), moderate (C: n=71) and severe (D: n=85) OSA. The patients of group C and D subdivided in those who accepted CPAP therapy (y) and those who refused it (n).The clinician who suggested CPAP therapy to each of the eligible patients was blinded about the results of the questionnaires. Results There were no differences between age, gender and body mass index in all groups. Both the patients of C(y) and D(y) subgroups, showed significant negative correlation between ZDRS and ESS (r=-0.384, p=0.036 and r=-0.556, p=0.01, correspondingly). The D(y) patients showed significant correlation between ZDRS and AIS (r=-0.400, p=0.011). These data were more pronounced when correlate the D(y) patients with ZDRS lower than 45 (ESS; r=-0.644, p=0.001, AIS; r=-0.474, p=0.026). Additionally, the ZDRS showed in D(y) group significant correlation with the subscales of SF-36, named; physical functioning (r=0.390, p=0.13), social functioning (r=0.331, p=0.37), and vitality/energy or fatigue (r=0.466, p=0.002). There were no any correlations between BQ, AIS, SF-36 and polysomnography data with the acceptance response of CPAP therapy in both C and D groups. Conclusions The ZDRS is a reliable and valid instrument for assessing depressive DD in OSA patients. In severe OSA patients when ZDRS score is lower than 45 and ESS over 10, then these values are promising prognostic factors of CPAP therapy acceptance.
Author Block: S. Tryfon1, T. Drakou2, M. Saroglou3, D. Kazis4, S. Papagiannopoulos5, P. A. Steiropoulos2; 1Pulmonary Clinic NHS General Hosp., Thessaloniki, Greece, 2Dimocritio Univ Thrace, General Hosp, Alexandroupoli, Greece, 3Pulmonary Dpt NHS, General Hosp., Drama, Greece, 4Neurology Clinic Aristotle University General Hosp., Thessaloniki, Greece, 5Neurology Clinic Aristotle Univ General Hosp., Thessaloniki, Greece.
Background and Objective Co-morbid insomnia with 39-58% of sleep apnea patients reduces the initial acceptance of continuous positive airway pressure (CPAP) therapy for Obstructive Sleep Apnea (OSA). The prevalence of depressive disorders (DD) in patients with OSA ranges from 5 to 63%. DD reported is of variable severity, diagnosed by clinical questionnaires or on the basis of the patient’s self-reported symptoms. Our work aims to examining the relationships between co-occurring DD and insomnia with OSA, and discuss treatment acceptance in a real life controlled trial. Methods All of 259 participants [72,4% men, mean age 52,91±13 years, (18-85 years) and body mass index (BMI)= 33,63±7,24kg/m2] who visited our lab in a year period, for sleep breathing disorders were included. Before the participants underwent for a polysomnography study they completed a battery of questionnaires; Epworth Sleepiness Scale (ESS), Short Form-36 Health Survey (SF-36), Berlin Questionairre (BQ), Athens Insomnia Scale (AIS), and ZUNG Self-Rating Depression Scale (ZDRS). The participants separated in 4 groups; no OSA (group A: n=56), mild (B: n=47), moderate (C: n=71) and severe (D: n=85) OSA. The patients of group C and D subdivided in those who accepted CPAP therapy (y) and those who refused it (n).The clinician who suggested CPAP therapy to each of the eligible patients was blinded about the results of the questionnaires. Results There were no differences between age, gender and body mass index in all groups. Both the patients of C(y) and D(y) subgroups, showed significant negative correlation between ZDRS and ESS (r=-0.384, p=0.036 and r=-0.556, p=0.01, correspondingly). The D(y) patients showed significant correlation between ZDRS and AIS (r=-0.400, p=0.011). These data were more pronounced when correlate the D(y) patients with ZDRS lower than 45 (ESS; r=-0.644, p=0.001, AIS; r=-0.474, p=0.026). Additionally, the ZDRS showed in D(y) group significant correlation with the subscales of SF-36, named; physical functioning (r=0.390, p=0.13), social functioning (r=0.331, p=0.37), and vitality/energy or fatigue (r=0.466, p=0.002). There were no any correlations between BQ, AIS, SF-36 and polysomnography data with the acceptance response of CPAP therapy in both C and D groups. Conclusions The ZDRS is a reliable and valid instrument for assessing depressive DD in OSA patients. In severe OSA patients when ZDRS score is lower than 45 and ESS over 10, then these values are promising prognostic factors of CPAP therapy acceptance.
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