Association between obstructive sleep apnea symptom subtypes and mental health

Obstructive sleep apnea (OSA) of varying severity significantly impacts mental health and quality of life. Recent studies have identified different OSA phenotypes, emphasizing symptom-based patient profiles. We sought to determine the association between symptom-based OSA phenotypes and depression.

This was an observational study including 1,083 patients (883 men and 200 women) who were part of a previous cohort study and who had been diagnosed with OSA on the basis of an apnea-hypopnea index ≥ 5 events/h on a home sleep apnea test. Sleep-related symptoms were assessed by the Epworth Sleepiness Scale (ESS) and self-reported sleep patterns. Objective respiratory parameters derived through polysomnography were used in order to characterize OSA severity. Depressive symptoms were evaluated with the Beck Depression Inventory (BDI). Cluster analysis defined three groups: nonsleepy patients; patients with disturbed sleep; and patients with excessive daytime sleepiness. Linear regression models were adjusted for age, sex, BMI, respiratory disturbance index, and total sleep time. A sensitivity analysis correlated ESS scores and total sleep time with BDI scores by means of Spearman correlation.

The median respiratory disturbance index was 21.6 events/h (IQR, 12.4-38.1), and the median ESS score was 8.0 (IQR, 5.0-12). A total of 431 patients (39.8%) were nonsleepy, 485 (44.7%) had disturbed sleep, and 167 (14.4%) presented with excessive daytime sleepiness, with a median BDI score of 12 (IQR, 6.0-53.1). Linear regression revealed higher depressive symptoms in patients with disturbed sleep and in those with excessive daytime sleepiness.

Patients with excessive daytime sleepiness and OSA have a higher risk of poor mental health. This underscores the need to address physiological and psychological aspects of OSA for improved patient well-being.