Depression and obstructive sleep apnea in patients with coronary heart disease
Robert M Carney1, William B Howells, Kenneth E Freedland
1Department of Psychiatry, Washington University School of Medicine, St. Louis, Missouri, USA. carneyr@bmc.wustl.edu
Insights
Major depression in coronary heart disease patients is linked to longer obstructive sleep apnea episodes, particularly in men. This finding highlights the connection between depression, sleep apnea, and cardiac risk.
Area of Science:
- Cardiology
- Sleep Medicine
- Psychiatry
Background:
- Depression is a known risk factor for cardiac events in patients with coronary heart disease (CHD).
- Obstructive sleep apnea/hypopnea syndrome (OSAHS) frequently co-occurs with depression and is also a cardiac risk factor.
- Undiagnosed OSAHS may contribute to the elevated cardiac risk observed in depressed individuals.
Purpose of the Study:
- To investigate the relationship between depression severity and the presence and characteristics of OSAHS in patients with CHD.
- To determine if OSAHS prevalence or severity differs among patients with major depression (MD), minor depression (md), and no depression (ND).
Main Methods:
- Medically stable patients with CHD were categorized into MD (n=53), md (n=36), or ND (n=43) groups.
- All participants underwent two nights of evaluation in a sleep medicine laboratory to assess for OSAHS.
- Key metrics included the prevalence of OSAHS, frequency and duration of apneic/hypopneic episodes, and oxygen desaturations.
Main Results:
- OSAHS prevalence did not significantly differ across depression groups (MD 66%, md 69%, ND 77%).
- Patients with MD exhibited significantly more frequent and longer apneic/hypopneic episodes and greater oxygen desaturations compared to the md group.
- While MD patients had longer apnea durations than ND patients, frequency of episodes and oxygen desaturations showed no significant difference between MD and ND groups, though gender-specific trends were noted.
Conclusions:
- OSAHS is not more prevalent in depressed patients with CHD.
- Major depression is associated with longer obstructive sleep apneic episodes in both male and female CHD patients.
- Men with major depression showed a tendency towards a higher frequency of obstructive episodes compared to men without depression.
Objective:
Depression is a risk factor for cardiac events in patients with coronary heart disease (CHD). Obstructive sleep apnea/hypopnea syndrome (OSAHS) is frequently comorbid with depression and is also a risk factor for cardiac events. Undetected OSAHS could help explain the increased risk associated with depression.
Methods:
Medically stable patients with CHD and major (MD, n = 53), minor (md, n = 36), or no depression (ND, n = 43) were evaluated for 2 nights in a sleep medicine laboratory.
Results:
The prevalence of OSAHS did not differ across groups (MD 66%, md 69%, ND 77%; p > .05). Patients with MD had a significantly greater frequency of apneic episodes, a significantly longer duration of apneas and hyponeas, and more oxygen desaturations per hour than those with md, but there were no differences between MD and ND in frequency of apneic episodes or oxygen desaturations. However, males with MD tended to have more obstructive episodes per hour than did ND males, whereas females with MD had fewer episodes than did ND females. Apnea duration was longer in patients with MD compared with patients with no ND. There was no difference in the mean duration of apnea per hour between the md and ND groups.
Conclusions:
Although OSAHS is not more common in depressed patients with CHD, MD is associated with longer obstructive sleep apneic episodes in both men and women and with a higher frequency of episodes in men.
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