SAN DIEGO -- Treating sleep disorders may improve depressive symptoms, researchers reported here.
In a retrospective study, positive airway pressure (PAP) therapy was associated with significantly improved scores on the Patient Health Questionnaire-2 (PHQ-2) over 6 months (mean decline -0.4, P<0.0001), Sachin Relia, MD, of the University of Tennessee Health Science Center in Memphis, and colleagues reported during a poster session at the American Psychiatric Association meeting here.
"PAP therapy, regardless of adherence, resulted in improved PHQ-2 scores," Relia told 51˶. "Having knowledge of comorbid sleep disorders and including evaluation of these in routine psychiatric assessments would significantly impact treatment outcomes."
Relia noted that 10% to 15% of patients with obstructive sleep apnea meet criteria for depressive disorders. For their study, they wanted to focus on whether PAP therapy -- and potentially, an attendant reduction in sleepiness -- could improve those symptoms.
They assessed electronic medical record data from 1,981 patients ages 18 and up evaluated at the Cleveland Clinic's Sleep Disorders Center between Jan. 1, 2010 and Dec. 31, 2014. Data included PHQ-2 scores, demographic measures, adherence, and medical history.
Most the patients in this study were middle-aged Caucasians, and about half were men. Adherence was defined as at least five or more days a week and at least four or more hours per day of PAP use.
The researchers also looked for clinically significant depression, noting that a PHQ-2 score of 3 or greater has previously been described to be the optimal cutoff for depression screening, with 83% sensitivity and 92% specificity for major depressive disorder.
His team looked at effects on depressive symptoms by adherence, and they also examined the effect of socioeconomic status on outcomes.
In addition to finding that PAP therapy was associated with improvement in PHQ-2 scores regardless of adherence, the researchers also found a significant reduction in the proportion of patients with clinically significant depression (PHQ-2 scores of 3 or higher) before and after PAP treatment (25.5% versus 17.3%, P<0.001).
Those reductions were significant for both adherent and non-adherent groups, Relia noted.
Benefits were robust for patients with excessive daytime sleepiness (those with an ESS of 10 or greater), the researchers found (mean change -0.6 versus -0.2, P<0.001). And in this group, there was a difference by adherence for those with clinically significant depression (mean change -1.6 versus -1.1, P=0.006), they found.
Multivariable regression analysis showed that patients with worse pre-PAP scores and those living in zip codes with lower median incomes garnered less benefit in depressive symptoms from PAP therapy (P<0.012).
"Patients with lower median incomes did not derive similar benefits, suggesting additional barriers to treatment effectiveness in these groups," Relia told 51˶.
Still, he concluded that since psychiatric disorders often co-occur with sleep disorders, and vice versa, having psychiatrists anticipate additional needs of the patient beyond psychological disorders allows for individualized treatment plans with the potential to improve patients' lives.
Disclosures
Relia disclosed no financial relationships with industry.
Primary Source
American Psychiatric Association
Kroenke K, Spitzer RL, Williams JB. "The Patient Health Questionnaire-2: Validity of a two-item depression screener" APA 2017.