Co‐morbid OSA and insomnia increases depression prevalence and severity in men

Jun 8, 2017Respirology (Carlton, Vic.)

Having both sleep apnea and insomnia increases depression rates and severity in men

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Abstract

The prevalence of co-morbid obstructive sleep apnoea and insomnia symptoms (COMISA) in community-dwelling men is 6.7%.

Men with COMISA show a higher prevalence of depression (42.6%) compared to those with only insomnia symptoms (21.6%) or obstructive sleep apnoea (8.4%).
Depression symptom scores are significantly higher in men with COMISA (mean PHQ-9 score of 16.1) than in those with DIMS-F (14.0) or OSA (11.4).
Respiratory and arousal indices in men with COMISA are similar to those observed in OSA.
Subjective sleep quality and daytime dysfunction scores in men with COMISA resemble those seen in DIMS-F.
Linear regression analysis indicates that predicted mean depression scores are higher in men with COMISA compared to those with DIMS-F alone.

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BACKGROUND AND OBJECTIVE: Obstructive sleep apnoea (OSA) and insomnia coexist in clinical populations but prevalence in the community and risk factors remain largely unknown. We examined the prevalence and profile of previously undiagnosed co-morbid OSA and insomnia symptoms (COMISA) in community-dwelling men.

METHODS: Men (n = 700, aged 58.5 ± 11.0 (mean ± SD) years) without a prior diagnosis of OSA completed full at-home unattended polysomnography, the Pittsburgh Sleep Quality Index and 36-item short form (SF-36) survey (2007-2012). Insomnia symptoms included difficulty initiating/maintaining sleep in the presence of daytime fatigue (DIMS-F). Depressive symptoms were assessed using the Beck Depression Inventory-1A, Centre for Epidemiological Studies Depression Scale and Patient Health Questionnaire-9 (PHQ-9) (2007-2010). Univariate (χand analysis of variance (ANOVA)) and multiple linear regressions were used to compare data from four groups of individuals: neither disorder; previously undiagnosed OSA (apnoea-hypopnoea index ≥ 10) or DIMS-F alone; and COMISA. 2

RESULTS: COMISA prevalence was 6.7%. Depression prevalence (COMISA, 42.6%; DIMS-F, 21.6%; OSA, 8.4%, χ = 71.6, P < 0.00) and symptom scale scores (e.g. PHQ-9 mean ± SD: 16.1 ± 5.5 c.f. 2

DIMS-F: 14.0 ± 4.9, P < 0.01 and OSA: 11.4 ± 3.0, P = 0.01) were highest in men with COMISA. In COMISA, respiratory and arousal indices were similar to those observed in OSA whilst reductions in subjective sleep and day dysfunction scores were similar to DIMS-F. After adjustment, predicted mean depression scores were all higher in DIMS-F and COMISA using linear regression (e.g. PHQ-9 β (95% CI): DIMS-F: 2.3 (1.2, 3.5); COMISA: 4.1 (3.0, 5.1)).

CONCLUSION: Men with COMISA have a greater prevalence, and severity, of depression than men with only one disorder.

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Co‐morbid OSA and insomnia increases depression prevalence and severity in men

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