Can depression contribute to the development of sleep apnea?

From the Guidelines

Depression can contribute to the development of sleep apnea, as it often causes sleep disturbances that may worsen or trigger sleep apnea symptoms. The relationship between depression and sleep apnea is complex and bidirectional, with depression potentially leading to changes in sleep architecture, such as increased REM sleep and decreased slow-wave sleep, which can affect breathing patterns during sleep 1. Additionally, depression may lead to weight gain due to reduced physical activity and medication side effects, and excess weight is a major risk factor for obstructive sleep apnea, as noted in the American Thoracic Society statement that obesity is a common risk factor, with 60–90% of patients with OSA presenting with a body mass index greater than 30 kg/m2 1. Some antidepressant medications can also cause muscle relaxation, potentially worsening airway collapse during sleep. Key factors to consider include:

• Changes in sleep architecture due to depression
• Weight gain associated with depression
• Potential effects of antidepressant medications on airway collapse
• The bidirectional relationship between depression and sleep apnea, where sleep apnea can also contribute to depression through chronic sleep fragmentation and oxygen desaturation. It is essential to address both depression and sleep apnea simultaneously, as treating one condition may help improve the other, and comprehensive treatment might include antidepressants, cognitive behavioral therapy for insomnia, weight management, and possibly CPAP therapy if sleep apnea is diagnosed.

From the Research

Association between Depression and Sleep Apnea

• Depression is a common comorbidity in patients with obstructive sleep apnea (OSA), with studies suggesting that up to 56.7% of patients with OSA may have clinically relevant depression 2.
• The relationship between depression and OSA is complex, with some studies suggesting that OSA may contribute to the development of depression, while others propose that depression may be a risk factor for OSA 3, 4.
• Symptoms of depression and OSA can overlap, making it challenging to diagnose and treat these conditions effectively 5, 6.

Mechanisms Linking Depression and Sleep Apnea

• Several possible mechanisms have been proposed to explain the link between depression and OSA, including the role of sleep fragmentation, hypoxia, and inflammation 3, 6.
• OSA may exacerbate depressive symptoms by disrupting sleep patterns, reducing oxygen saturation, and increasing stress hormones 2, 5.
• Depression may also contribute to the development of OSA by increasing the risk of obesity, hypertension, and other comorbid conditions that can worsen OSA symptoms 4, 5.

Clinical Implications

• Patients with OSA should be screened for depressive disorders, and those with depression should be evaluated for OSA 2, 6.
• Treatment of OSA with continuous positive airway pressure (CPAP) may improve depressive symptoms, but further research is needed to establish the effectiveness of this approach 2, 5.
• A comprehensive treatment plan that addresses both depression and OSA may be necessary to improve outcomes for patients with these comorbid conditions 3, 6.