Skip to main content
Top
Published in: Sleep and Breathing 3/2011

01-09-2011 | Original Article

The contribution of fatigue and sleepiness to depression in patients attending the sleep laboratory for evaluation of obstructive sleep apnea

Authors: Melinda L. Jackson, Con Stough, Mark E. Howard, Jo Spong, Luke A. Downey, Bruce Thompson

Published in: Sleep and Breathing | Issue 3/2011

Login to get access

Abstract

Purpose

A high prevalence of depressive symptomatology has been reported amongst sufferers of obstructive sleep apnea (OSA), but it remains unclear as to whether this is due to their OSA or other factors associated with the disorder. The current study aimed to assess the incidence and aetiology of depression in a community sample of individuals presenting to the sleep laboratory for diagnostic assessment of OSA.

Methods

Forty-five consecutive individuals who presented to the sleep laboratory were recruited; of those, 34 were diagnosed with OSA, and 11 were primary snorers with no clinical or laboratory features of OSA. Nineteen control subjects were also recruited. Patients and controls completed the Beck Depression Inventory, the Profile of Mood States (POMS), and the Epworth Sleepiness Scale to assess their mood and sleepiness, prior to their polysomnography.

Results

All patients reported significantly more depressive symptoms compared with healthy controls, regardless of their degree of OSA. There were no significant differences between OSA patients and primary snorers on any of the mood and self-rated sleepiness measures. Depression scores were not significantly associated with any of the nocturnal variables. Regression analysis revealed that the POMS fatigue subscale explained the majority of the variance in subjects' depression scores.

Conclusions

Fatigue was the primary predictor of the level of depressive symptoms in patients who attended the sleep laboratory, regardless of the level of severity of sleep-disordered breathing. When considering treatment options, practitioners should be aware of the concomitant occurrence of depressive symptoms and fatigue in patients presenting with sleep complaints, which may not be due to a sleep disorder.
Literature
1.
go back to reference Ohayon MM (2007) Epidemiology of depression and its treatment in the general population. J Psychiatric Res 41:207CrossRef Ohayon MM (2007) Epidemiology of depression and its treatment in the general population. J Psychiatric Res 41:207CrossRef
2.
go back to reference Kales A, Caldwell AB, Cadieux RJ, Vela-Bueno A, Ruch LG, Mayes SD (1985) Severe obstructive sleep apnea–II: associated psychopathology and psychosocial consequences. J Chron Dis 38:427–434PubMedCrossRef Kales A, Caldwell AB, Cadieux RJ, Vela-Bueno A, Ruch LG, Mayes SD (1985) Severe obstructive sleep apnea–II: associated psychopathology and psychosocial consequences. J Chron Dis 38:427–434PubMedCrossRef
3.
go back to reference Aloia MS, Arnedt JT, Smith L, Skrekas J, Stanchina M, Millman RP (2005) Examining the construct of depression in obstructive sleep apnea syndrome. Sleep Med 6:115–121PubMedCrossRef Aloia MS, Arnedt JT, Smith L, Skrekas J, Stanchina M, Millman RP (2005) Examining the construct of depression in obstructive sleep apnea syndrome. Sleep Med 6:115–121PubMedCrossRef
4.
go back to reference Schwartz D, Kohler W, Karatinos G (2005) Symptoms of depression in individuals with obstructive sleep apnea may be amendable to treatment with continuous positive airway pressure. Chest 128:1304–1309PubMedCrossRef Schwartz D, Kohler W, Karatinos G (2005) Symptoms of depression in individuals with obstructive sleep apnea may be amendable to treatment with continuous positive airway pressure. Chest 128:1304–1309PubMedCrossRef
5.
go back to reference Harris M, Glozier N, Ratnavadivel R, Grunstein RR (2009) Obstructive sleep apnea and depression. Sleep Med Rev 13:437–444PubMedCrossRef Harris M, Glozier N, Ratnavadivel R, Grunstein RR (2009) Obstructive sleep apnea and depression. Sleep Med Rev 13:437–444PubMedCrossRef
6.
go back to reference Reynolds C, Kupfer D, McEachran A, Taska L, Sewitch D, Coble P (1989) Depressive psychopathology in male sleep apneics. J Clin Psychiatry 45:287–290 Reynolds C, Kupfer D, McEachran A, Taska L, Sewitch D, Coble P (1989) Depressive psychopathology in male sleep apneics. J Clin Psychiatry 45:287–290
7.
go back to reference Mendelson W (1992) Depression in obstructive sleep apnoea patients. Sleep Res 21:230 Mendelson W (1992) Depression in obstructive sleep apnoea patients. Sleep Res 21:230
8.
9.
go back to reference Kessler RC, Berglund P, Demler O, Jin R, Koretz D et al (2003) The epidemiology of major depressive disorder: results from the National Comorbidity Survey Replication (NCS-R). JAMA 289:3095–3105PubMedCrossRef Kessler RC, Berglund P, Demler O, Jin R, Koretz D et al (2003) The epidemiology of major depressive disorder: results from the National Comorbidity Survey Replication (NCS-R). JAMA 289:3095–3105PubMedCrossRef
10.
go back to reference Young T, Palta M, Dempsey J, Skatrud J, Weber S, Badr S (1993) The occurrence of sleep-disordered breathing among middle-aged adults. N Engl J Med 328:1230–1235PubMedCrossRef Young T, Palta M, Dempsey J, Skatrud J, Weber S, Badr S (1993) The occurrence of sleep-disordered breathing among middle-aged adults. N Engl J Med 328:1230–1235PubMedCrossRef
11.
go back to reference Kessler R, Zhao S, Blazer D, Swartz M (1997) Prevalence, correlates, and course of minor depression and major depression in the national comorbidity survey. J Affect Dis 45:19–30PubMedCrossRef Kessler R, Zhao S, Blazer D, Swartz M (1997) Prevalence, correlates, and course of minor depression and major depression in the national comorbidity survey. J Affect Dis 45:19–30PubMedCrossRef
12.
go back to reference Murry C, Lopez A (1996) Evidence-based health policy: lessons from the Global Burden of Disease Study. Science 274:740–743CrossRef Murry C, Lopez A (1996) Evidence-based health policy: lessons from the Global Burden of Disease Study. Science 274:740–743CrossRef
13.
go back to reference Sforza E, de Saint HZ, Pelissolo A, Rochat T, Ibanez V (2002) Personality, anxiety and mood traits in patients with sleep-related breathing disorders: effect of reduced daytime alertness. Sleep Med 3:139–145PubMedCrossRef Sforza E, de Saint HZ, Pelissolo A, Rochat T, Ibanez V (2002) Personality, anxiety and mood traits in patients with sleep-related breathing disorders: effect of reduced daytime alertness. Sleep Med 3:139–145PubMedCrossRef
14.
go back to reference Aitkins J, Caruana-Montaldo B, Vanable P, Tadimeti L, Mendelson W (1999) MMPI correlates of sleep and respiratory disturbance in obstructive sleep apnoea. Sleep 22:362–369 Aitkins J, Caruana-Montaldo B, Vanable P, Tadimeti L, Mendelson W (1999) MMPI correlates of sleep and respiratory disturbance in obstructive sleep apnoea. Sleep 22:362–369
15.
go back to reference Pillar G, Lavie P (1998) Psychiatric symptoms in sleep apnea syndrome: effects of genderand respiratory disturbance index. Chest 114:697–703PubMedCrossRef Pillar G, Lavie P (1998) Psychiatric symptoms in sleep apnea syndrome: effects of genderand respiratory disturbance index. Chest 114:697–703PubMedCrossRef
16.
go back to reference Bardwell W, Berry C, A-I S, Dimsdale J (1999) Psychological correlates of sleep apnea. J Psychosom Res 47:583–596PubMedCrossRef Bardwell W, Berry C, A-I S, Dimsdale J (1999) Psychological correlates of sleep apnea. J Psychosom Res 47:583–596PubMedCrossRef
17.
go back to reference Bardwell WA, Moore P, Ancoli-Israel S, Dimsdale JE (2003) Fatigue in obstructive sleep apnea: driven by depressive symptoms instead of apnea severity? Am J Psychiatry 160:350–355PubMedCrossRef Bardwell WA, Moore P, Ancoli-Israel S, Dimsdale JE (2003) Fatigue in obstructive sleep apnea: driven by depressive symptoms instead of apnea severity? Am J Psychiatry 160:350–355PubMedCrossRef
18.
go back to reference Mills P, Kim J-H, Bardwell W, Hong S, Dimsdale J (2008) Predictors of fatigue in obstructive sleep apnea. Sleep Breath 12:397–399PubMedCrossRef Mills P, Kim J-H, Bardwell W, Hong S, Dimsdale J (2008) Predictors of fatigue in obstructive sleep apnea. Sleep Breath 12:397–399PubMedCrossRef
19.
go back to reference Bedard MA, Montplaisir J, Richer F, Rouleau I, Malo J (1991) Obstructive sleep apnea syndrome: pathogenesis of neuropsychological deficits. J Clin Exp Neuropsychol 13:950–964PubMedCrossRef Bedard MA, Montplaisir J, Richer F, Rouleau I, Malo J (1991) Obstructive sleep apnea syndrome: pathogenesis of neuropsychological deficits. J Clin Exp Neuropsychol 13:950–964PubMedCrossRef
20.
go back to reference Beebe DW, Gozal D (2002) Obstructive sleep apnea and the prefrontal cortex: towards a comprehensive model linking nocturnal upper airway obstruction to daytime cognitive and behavioral deficits. J Sleep Res 11:1–16PubMedCrossRef Beebe DW, Gozal D (2002) Obstructive sleep apnea and the prefrontal cortex: towards a comprehensive model linking nocturnal upper airway obstruction to daytime cognitive and behavioral deficits. J Sleep Res 11:1–16PubMedCrossRef
21.
go back to reference Naismith S, Winter V, Gotsopoulos H, Hickie I, Cistulli P (2004) Neurobehavioral functioning in obstructive sleep apnea: differential effects of sleep quality, hypoxemia and subjective sleepiness. J Clin Exp Neuropsychol 26:43–54PubMedCrossRef Naismith S, Winter V, Gotsopoulos H, Hickie I, Cistulli P (2004) Neurobehavioral functioning in obstructive sleep apnea: differential effects of sleep quality, hypoxemia and subjective sleepiness. J Clin Exp Neuropsychol 26:43–54PubMedCrossRef
22.
go back to reference American Psychological Association (1994) Diagnostic and Statistical Manual of Mental Disorders. American Psychiatric Association, Washington, DC American Psychological Association (1994) Diagnostic and Statistical Manual of Mental Disorders. American Psychiatric Association, Washington, DC
23.
go back to reference Shen J, Barbera J, Shapiro CM (2006) Distinguishing sleepiness and fatigue: focus on definition and measurement. Sleep Med Rev 10:63–76PubMedCrossRef Shen J, Barbera J, Shapiro CM (2006) Distinguishing sleepiness and fatigue: focus on definition and measurement. Sleep Med Rev 10:63–76PubMedCrossRef
24.
go back to reference Johns MW (1993) Daytime sleepiness, snoring, and obstructive sleep apnea. The Epworth sleepiness scale. Chest 103:30–36PubMedCrossRef Johns MW (1993) Daytime sleepiness, snoring, and obstructive sleep apnea. The Epworth sleepiness scale. Chest 103:30–36PubMedCrossRef
25.
go back to reference Bardwell WA, Ancoli-Israel S, Dimsdale JE (2007) Comparison of the effects of depressive symptoms and apnea severity on fatigue in patients with obstructive sleep apnea: a replication study. J Affective Dis 97:181–186CrossRef Bardwell WA, Ancoli-Israel S, Dimsdale JE (2007) Comparison of the effects of depressive symptoms and apnea severity on fatigue in patients with obstructive sleep apnea: a replication study. J Affective Dis 97:181–186CrossRef
26.
go back to reference Aikens J, Mendelson W (1999) A matched comparison of MMPI responses in patients with primary snoring or obstructive sleep apnea. Sleep 22:355–359PubMed Aikens J, Mendelson W (1999) A matched comparison of MMPI responses in patients with primary snoring or obstructive sleep apnea. Sleep 22:355–359PubMed
27.
go back to reference The Report of an American Academy of Sleep Medicine Task Force (1999) Sleep-related breathing disorders in adults: recommendations for syndrome definition and measurement techniques in clinical research. Sleep 22:667–689 The Report of an American Academy of Sleep Medicine Task Force (1999) Sleep-related breathing disorders in adults: recommendations for syndrome definition and measurement techniques in clinical research. Sleep 22:667–689
28.
go back to reference Johns MW (1991) A new method for measuring daytime sleepiness: the Epworth sleepiness scale. Sleep 14:540–545PubMed Johns MW (1991) A new method for measuring daytime sleepiness: the Epworth sleepiness scale. Sleep 14:540–545PubMed
29.
go back to reference Beck A, Steer R, Brown G (1996) Beck Depression Inventory-II Manual. The Psychological Society, San Antonio Beck A, Steer R, Brown G (1996) Beck Depression Inventory-II Manual. The Psychological Society, San Antonio
30.
go back to reference Banks S, Barnes M, Tarquinio N, Pierce RJ, Lack LC, Doug McEvoy R (2004) Factors associated with maintenance of wakefulness test mean sleep latency in patients with mild to moderate obstructive sleep apnoea and normal subjects. J Sleep Res 13:71–78PubMedCrossRef Banks S, Barnes M, Tarquinio N, Pierce RJ, Lack LC, Doug McEvoy R (2004) Factors associated with maintenance of wakefulness test mean sleep latency in patients with mild to moderate obstructive sleep apnoea and normal subjects. J Sleep Res 13:71–78PubMedCrossRef
31.
go back to reference Barnes M, McEvoy RD, Banks S, Tarquinio N, Murray CG et al (2004) Efficacy of positive airways pressure and oral appliance in mild to moderate obstructive sleep apnea. Am J Respir Crit Care Med 170:656–664PubMedCrossRef Barnes M, McEvoy RD, Banks S, Tarquinio N, Murray CG et al (2004) Efficacy of positive airways pressure and oral appliance in mild to moderate obstructive sleep apnea. Am J Respir Crit Care Med 170:656–664PubMedCrossRef
32.
go back to reference McNair D, Lorr M, Droppleman L (1992) EdITS Manual for the Profile of Mood States. EdITS, San Diago, CA McNair D, Lorr M, Droppleman L (1992) EdITS Manual for the Profile of Mood States. EdITS, San Diago, CA
33.
go back to reference Rechtschaffen A, Kales A (1968) A manual of standardized terminolgy, techniques and scoring system for sleep stages in human subjects. The National Institutes of Health, Washington DC Rechtschaffen A, Kales A (1968) A manual of standardized terminolgy, techniques and scoring system for sleep stages in human subjects. The National Institutes of Health, Washington DC
34.
go back to reference Redline S, Kapur VK, Sanders MH, Quan SF, Gottlieb DJ et al (2000) Effects of varying approaches for identifying respiratory disturbances on sleep apnea assessment. Am J Respir Crit Care Med 161:369–374PubMed Redline S, Kapur VK, Sanders MH, Quan SF, Gottlieb DJ et al (2000) Effects of varying approaches for identifying respiratory disturbances on sleep apnea assessment. Am J Respir Crit Care Med 161:369–374PubMed
35.
go back to reference Kales A, Caldwell A, Cadieux R, Vela-Bueno A, Ruch L, Mayes S (1985) Severe obstructive sleep apnea–II: associated psychopathology and psychosocial consequences. J Chronic Dis 38:427–434PubMedCrossRef Kales A, Caldwell A, Cadieux R, Vela-Bueno A, Ruch L, Mayes S (1985) Severe obstructive sleep apnea–II: associated psychopathology and psychosocial consequences. J Chronic Dis 38:427–434PubMedCrossRef
36.
go back to reference Barnes M, Houston D, Worsnop CJ, Neill AM, Mykytyn IJ et al (2002) A randomized controlled trial of continuous positive airway pressure in mild obstructive sleep apnea. Am J Respir Crit Care Med 165:773–780PubMed Barnes M, Houston D, Worsnop CJ, Neill AM, Mykytyn IJ et al (2002) A randomized controlled trial of continuous positive airway pressure in mild obstructive sleep apnea. Am J Respir Crit Care Med 165:773–780PubMed
37.
go back to reference Engleman HM, Martin SE, Deary IJ, Douglas NJ (1997) Effect of CPAP therapy on daytime function in patients with mild sleep apnoea/hypopnoea syndrome. Thorax 52:114–119PubMedCrossRef Engleman HM, Martin SE, Deary IJ, Douglas NJ (1997) Effect of CPAP therapy on daytime function in patients with mild sleep apnoea/hypopnoea syndrome. Thorax 52:114–119PubMedCrossRef
38.
go back to reference Haba-Rubio J, Staner L, Krieger J, Macher JP (2005) Periodic limb movements and sleepiness in obstructive sleep apnea patients. Sleep Med 6:225–229PubMedCrossRef Haba-Rubio J, Staner L, Krieger J, Macher JP (2005) Periodic limb movements and sleepiness in obstructive sleep apnea patients. Sleep Med 6:225–229PubMedCrossRef
39.
go back to reference Guilleminault C, Stoohs R, Clerk A, Cetel M, Maistors P (1993) Excessive daytime sleepiness: the upper airway resistance syndrome. Chest 104:781–787PubMedCrossRef Guilleminault C, Stoohs R, Clerk A, Cetel M, Maistors P (1993) Excessive daytime sleepiness: the upper airway resistance syndrome. Chest 104:781–787PubMedCrossRef
40.
go back to reference Young T, Hutton R, Finn L, Badr S, Palta M (1996) The gender bias in sleep apnea diagnosis. Are women missed because they have different symptoms? Arch Intern Med 156:2445–2451PubMedCrossRef Young T, Hutton R, Finn L, Badr S, Palta M (1996) The gender bias in sleep apnea diagnosis. Are women missed because they have different symptoms? Arch Intern Med 156:2445–2451PubMedCrossRef
41.
go back to reference Weissman MM, Bland R, Joyce PR, Newman S, Wells JE, Wittchen H-U (1993) Sex differences in rates of depression: cross-national perspectives. J Affective Dis 29:77–84CrossRef Weissman MM, Bland R, Joyce PR, Newman S, Wells JE, Wittchen H-U (1993) Sex differences in rates of depression: cross-national perspectives. J Affective Dis 29:77–84CrossRef
Metadata
Title
The contribution of fatigue and sleepiness to depression in patients attending the sleep laboratory for evaluation of obstructive sleep apnea
Authors
Melinda L. Jackson
Con Stough
Mark E. Howard
Jo Spong
Luke A. Downey
Bruce Thompson
Publication date
01-09-2011
Publisher
Springer-Verlag
Published in
Sleep and Breathing / Issue 3/2011
Print ISSN: 1520-9512
Electronic ISSN: 1522-1709
DOI
https://doi.org/10.1007/s11325-010-0355-2

Other articles of this Issue 3/2011

Sleep and Breathing 3/2011 Go to the issue
Live Webinar | 27-06-2024 | 18:00 (CEST)

Keynote webinar | Spotlight on medication adherence

Live: Thursday 27th June 2024, 18:00-19:30 (CEST)

WHO estimates that half of all patients worldwide are non-adherent to their prescribed medication. The consequences of poor adherence can be catastrophic, on both the individual and population level.

Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.

Prof. Kevin Dolgin
Prof. Florian Limbourg
Prof. Anoop Chauhan
Developed by: Springer Medicine
Obesity Clinical Trial Summary

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.

Developed by: Springer Medicine