Evaluation of perceptions of general physicians regarding the association of obstructive sleep apnoea with depression in the real world setting in the United Kingdom
Keywords:Depression, Obstructive sleep apnoea, OSA, General practitioners
Background: Patients with depression may also have obstructive sleep apnoea (OSA). Management of OSA in patients with depression may improve depression and neurocognitive functions. Hence it is important to identify OSA early when assessing patients with depression or cognitive impairment. Aim of the study was to evaluate the knowledge attitude and practices of general practitioners (GPs) in the United Kingdom (UK) regarding OSA in patients with depression.
Methods: A questionnaire (11 questions) regarding OSA symptoms and relevant questions to be asked during history taking by the GP was prepared. Twenty GPs across UK were sent the questionnaire by email and were asked to send their responses to the questionnaire.
Results: All the respondents concurred that OSA can have a correlation with depression. Yet, only 33% of respondents asked questions related to OSA to their patients. 67% of GPs reported not asking their patients relevant questions about OSA citing lack of time. The symptom most commonly reported by their patients was difficulty concentrating during the day. 79% GPs reported that they diagnosed OSA from the history in less than 10% of their patients. The chief barriers for initiating treatment for OSA in patients with depression included need for referral of patients with OSA to a specialist (50%), patient acceptance (34%) and 13% GPs were uncertain about the barriers to initiating treatment.
Conclusions: Primary care physician should determine the underlying cause of depression rather than simply diagnosing the patient as depressed. OSA must be evaluated in patients with depression by the primary care physician.
Gupta MA, Simpson FC. Obstructive sleep apnea and psychiatric disorders: a systematic review. J Clin Sleep Med. 2015;11(2):165-75.
Vanek J, Prasko J, Genzor S, Ociskova M, Kantor K, Holubova M, Slepecky M, Nesnidal V, Kolek A, Sova M. Obstructive sleep apnea, depression and cognitive impairment. Sleep Med. 2020;72:50-8.
Garbarino S, Bardwell WA, Guglielmi O, Chiorri C, Bonanni E, Magnavita N. Association of Anxiety and Depression in Obstructive Sleep Apnea Patients: A Systematic Review and Meta-Analysis. Behav Sleep Med. 2020;18(1):35-57.
Slowik JM, Collen JF. Obstructive Sleep Apnea. In: Stat Pearls. Treasure Island (FL): StatPearls Publishing. 2021.
Kerner NA, Roose SP. Obstructive Sleep Apnea is Linked to Depression and Cognitive Impairment: Evidence and Potential Mechanisms. Am J Geriatr Psychiatry. 2016;24(6):496-508.
Hobzova M, Prasko J, Vanek J, Ociskova M, Genzor S, Holubova M, Grambal A, Latalova K. Depression and obstructive sleep apnea. Neuro Endocrinol Lett. 2017;38(5):343-52.
Ishman SL, Cavey RM, Mettel TL, Gourin CG. Depression, sleepiness, and disease severity in patients with obstructive sleep apnea. Laryngoscope. 2010;120(11):2331-5.
Edwards C, Almeida OP, Ford AH. Obstructive sleep apnea and depression: A systematic review and meta-analysis. Maturitas. 2020;142:45-54.
Lang CJ, Appleton SL, Vakulin A, McEvoy RD, Wittert GA, Martin SA, Catcheside PG, Antic NA, Lack L, Adams RJ. Co-morbid OSA and insomnia increases depression prevalence and severity in men. Respirology. 2017;22(7):1407-15.
Johns MW. A new method for measuring daytime sleepiness: the Epworth sleepiness scale. Sleep. 1991;14:540-5.
Weaver TE, Laizner AM, Evans LK, Maislin G, Chugh DK, Lyon K, Smith PL, Schwartz AR, Redline S, Pack AI, Dinges DF. An instrument to measure functional status outcomes for disorders of excessive sleepiness. Sleep. 1997;20:835-43.
Schröder CM, O'Hara R. Depression and Obstructive Sleep Apnea (OSA). Ann Gen Psychiatry. 2005;4:13.
Millman RP, Fogel BS, McNamara ME, Carlisle CC. Depression as a manifestation of obstructive sleep apnea: reversal with nasal continuous positive airway pressure. J Clin Psychiatry. 1989;50:348-51.
Young T, Hutton R, Finn L, Badr S, Palta M. The gender bias in sleep apnea diagnosis. Are women missed because they have different symptoms? Arch Intern Med. 1996;156:2445-51.
Collop NA, Adkins D, Phillips BA. Gender differences in sleep and sleep-disordered breathing. Clin Chest Med. 2004;25:257-68.
Quintana-Gallego E, Carmona-Bernal C, Capote F, Sanchez-Armengol A, Botebol-Benhamou G, Polo-Padillo J, Castillo-Gomez J. Gender differences in obstructive sleep apnea syndrome: a clinical study of 1166 patients. Respir Med. 2004;98:984-9.
Adrien J. Neurobiological bases for the relation between sleep and depression. Sleep Med Rev. 2002;6:341-51.
Habukawa M, Uchimura N, Kakuma T. Effect of CPAP treatment on residual depressive symptoms in patients with major depression and coexisting sleep apnea: contribution of daytime sleepiness to residual depressive symptoms. Sleep Med. 2010;11:552-7.
El-Sherbini AM, Bediwy AS, El-Mitwalli A. Association between obstructive sleep apnea (OSA) and depression and the effect of continuous positive airway pressure (CPAP) treatment. Neuropsychiatr Dis Treat. 2011;7:715-21.