Obstructive Sleep Apnea and Its Association with Sleep Quality, Daytime Sleepiness, Depression and Attention Span
OSA, Sleep, Depression and Attention
Vol. 16 No. 1 : 2021 (163-176)
Abstract
Obstructive sleep apnoea (OSA) has multiple physical and psychosocial effects on individuals. Therefore, this study aims to determine the sleep quality, daytime sleepiness, depression and attention span in patients with OSA. This was a cross-sectional study among patients who were recently diagnosed with OSA in a Malaysian hospital. The socio-demographic and clinical data, Epworth Sleepiness Scale, Pittsburgh Sleep Quality Index, Patients Health Questionnaire and Comprehensive Trail Making Test were used as instruments. Findings were analysed and presented using Chi-Square, One-Way ANOVA and Independent-Sample T-test statistical analyses. Most of the respondents presented with poor sleep quality and impaired attention span. Approximately, half of the respondents had excessive daytime sleepiness. There were significant associations between sleep quality and daytime sleepiness (p-value=0.051), daytime sleepiness with depression (p-value=0.049) and severity of OSA with depression (p-value=0.026). Daytime sleepiness was significantly associated with working status (p-value=0.009) and driving status (p-value=0.033). In conclusion, most patients with OSA had poor sleep quality, excessive daytime sleepiness, and impaired attention span. Hence, OSA should be diagnosed and treated early, particularly in patients who are still working and actively driving.
Keywords :
attention,
Obstructive Sleep Apnea,
psychological,
sleep,
Correspondance Address
Associate Professor Dr. Suzaily Wahab. Department of Psychiatry, Faculty of Medicine, Universiti Kebangsaan Malaysia Medical Centre, Jalan Yaacob Latif, Bandar Tun Razak, 56000 Cheras, Kuala Lumpur, Malaysia. Tel: +603-9145 5555 ext 6142 Email: suzailywhb@yahoo.com
References
André, S., Andreozzi, F., Van Overstraeten, C., Ben Youssef, S., Bold, I., Carlier, S., Gruwez, A., Bruyneel, A.V., Bruyneel, M. 2020. Cardiometabolic comorbidities in obstructive sleep apnea patients are related to disease severity, nocturnal hypoxemia, and decreased sleep quality. Respir Res 21(1): 35.
Asghari, A., Mohammadi, F., Kamrava, S.K., Tavakoli, S., Farhadi, M. 2012. Severity of depression and anxiety in obstructive sleep apnea syndrome. Eur Arch Otorhinolaryngol 269(12): 2549-53.
Ayalon, L., Ancoli-Israel, S., Aka, A.A., McKenna, B.S., Drummond, S.P. 2009. Relationship between obstructive sleep apnea severity and brain activation during a sustained attention task. Sleep 32(3): 373-81.
BaHammam, A.S., Kendzerska, T., Gupta, R., Ramasubramanian, C., Neubauer, D.N., Narasimhan, M., Pandi-Perumal, S.R., Moscovitch, A. 2016. Comorbid depression in obstructive sleep apnea: an under-recognized association. Sleep Breath 20(2): 447-56.
Benjafield, A.V., Ayas, N.T., Eastwood, P.R., Heinzer, R., Ip, M.S.M., Morrell, M.J., Nunez, C.M., Patel, S.R., Penzel, T., Pépin, J.L., Peppard, P.E., Sinha, S., Tufik, S., Valentine, K., Malhotra, A. 2019. Estimation of the global prevalence and burden of obstructive sleep apnoea: a literature-based analysis. Lancet Respir Med 7(8): 687-98.
Bjorvatn, B., Rajakulendren, N., Lehmann, S., Pallesen, S. 2018. Increased severity of obstructive sleep apnea is associated with less anxiety and depression. J Sleep Res 27(6): e12467.
Canessa, N., Castronovo, V., Cappa, S.F., Aloia, M.S., Marelli, S., Falini, A., Alemanno, F., Ferini-Strambi, L. 2011. Obstructive sleep apnea: brain structural changes and neurocognitive function before and after treatment. Am J Respir Crit Care Med 183(10): 1419-26.
Carskadon, M.A., Dement, W.C. 2005. Normal human sleep: an overview. Principles Practice Sleep Med 4: 13-23.
Chami, H.A., Baldwin, C.M., Silverman, A., Zhang, Y., Rapoport, D., Punjabi, N.M., Gottlieb, D.J. 2010. Sleepiness, quality of life, and sleep maintenance in REM versus Non-REM Sleep-Disordered Breathing. Am J Respir Crit Care Med 181(9): 997-1002.
Chatterjee, P., Sen, M., Suri, J. 2012. Prevalence of depression and anxiety in patients with sleep-disordered breathing and its correlation with disease severity. Indian J Sleep Med 7(2): 55.
Chellappa, S.L., Schröder, C., Cajochen, C. 2009. Chronobiology, excessive daytime sleepiness and depression: is there a link? Sleep Med 10(5): 505-14.
Dickinson, D.L., Wolkow, A.P., Rajaratnam, S.M.W., Drummond, S.P.A. 2018. Personal sleep debt and daytime sleepiness mediate the relationship between sleep and mental health outcomes in young adults. Depress Anxiety 35(8): 775-83.
Dong, Z., Xu, X., Wang, C., Cartledge, S., Maddison, R., Shariful Islam, S.M. 2020. Association of Overweight and Obesity with Obstructive Sleep Apnoea: A Systematic Review and Meta-Analysis. Obes Med 17: 100185
Farah, N.M., Saw Yee, T., Mohd Rasdi, H.F. 2019. Self-reported sleep quality using the malay version of the pittsburgh sleep quality index (PSQI-M) in Malaysian Adults. Int J Environ Res Public Health 16(23): 4750.
Fischer, J., Dogas, Z., Bassetti, C.L., Berg, S., Grote, L., Jennum, P., Levy, P., Mihaicuta, S., Nobili, L., Riemann, D., Puertas Cuesta, F.J., Raschke, F., Skene, D.J., Stanley, N., Pevernagie, D. 2012. Standard procedures for adults in accredited sleep medicine centres in Europe. J Sleep Res 21(4): 357-68.
Flemons, W.W. 2002. Clinical practice. Obstructive sleep apnea. N Engl J Med 347(7): 498-504.
Germain, A., Kupfer, D.J. 2008. Circadian rhythm disturbances in depression. Hum Psychopharmacol 23(7): 571-85.
Gharibeh, T., Mehra, R. 2010. Obstructive sleep apnea syndrome: natural history, diagnosis, and emerging treatment options. Nat Sci Sleep 2: 233-55.
Gray, R. 2006. Comprehensive Trail Making Test. J Psychoeduc Assess 24(1): 88-91.
Gupta, M.A., Simpson, F.C. 2015. Obstructive Sleep Apnea and Psychiatric Disorders: A Systematic Review. J Clin Sleep Med 11(2): 165-75.
Hamilton, G.S., Joosten, S.A. 2017. Obstructive Sleep Apnoea and Obesity. Aust Fam Physician 46(7): 460-3.
Irwin, M.R., Miller, A.H. 2007. Depressive disorders and immunity: 20 years of progress and discovery. Brain Behav Immun 21(4): 374-83.
Kasasbeh, E., Chi, D.S., Krishnaswamy, G. 2006. Inflammatory aspects of sleep apnea and their cardiovascular consequences. South Med J 99(1): 58-67.
Katon, W., Lin, E.H., Kroenke, K. 2007. The association of depression and anxiety with medical symptom burden in patients with chronic medical illness. Gen Hosp Psychiatry 29(2): 147-55.
Kositanurit, W., Muntham, D., Udomsawaengsup, S., Chirakalwasan, N. 2018. Prevalence and associated factors of obstructive sleep apnea in morbidly obese patients undergoing bariatric surgery. Sleep Breath 22(1): 251-6.
LaGrotte, C., Fernandez-Mendoza, J., Calhoun, S.L., Liao, D., Bixler, E.O., Vgontzas, A.N. 2016. The relative association of obstructive sleep apnea, obesity and excessive daytime sleepiness with incident depression: a longitudinal, population-based study. Int J Obes 40(9): 1397-404.
Lau, E.Y., Eskes, G.A., Morrison, D.L., Rajda, M., Spurrm K.F. 2013. The role of daytime sleepiness in psychosocial outcomes after treatment for obstructive sleep apnea. Sleep Disord 2013: 1–10.
Lee, S.A., Yoon, H., Kim, H.W. 2019. Is severe obstructive sleep apnea associated with less depressive symptoms? J Psychosom Res 122: 6-12.
Lusic Kalcina, L., Valic, M., Pecotic, R., Pavlinac Dodig, I., Dogas, Z. 2017. Good and poor sleepers among osa patients: sleep quality and overnight polysomnography findings. Neurol Sci 38(7): 1299-1306.
Macey, P.M., Woo, M.A., Kumar, R., Cross, R.L., Harper, R.M. 2010. Relationship between obstructive sleep apnea severity and sleep, depression and anxiety symptoms in newly-diagnosed patients. PLoS ONE 5(4): 1-6.
Naismith, S., Winter, V., Gotsopoulos, H., Hickie, I., Cistulli, P. 2004. Neurobehavioral functioning in obstructive sleep apnea: differential effects of sleep quality, hypoxemia and subjective sleepiness. J Clin Exp Neuropsychol 26(1): 43-54.
Ozer, C., Etcibaşı, S., Öztürk, L. 2014. Daytime sleepiness and sleep habits as risk factors of traffic accidents in a group of Turkish public transport drivers. Int J Clin Exp Med 7(1): 268-73.
Qaseem, A., Dallas, P., Owens, D.K., Starkey, M., Holty, J.E., Shekelle, P. 2014. Diagnosis of obstructive sleep apnea in adults: a clinical practice guideline from the american college of physicians. Ann Intern Med 161(3): 210-20.
Pedersen, N.R. 2019. Comparison of subjective sleep quality and daytime sleepiness with whole-night polysomnography findings in sleep apnea patients. Diploma thesis. Universitt of Split School of Medicine.
Rashid, R., Ahmad, S., Jaffar, A., Ali, F., Paidi, N. 2014. Determinants of patients at risk of developing obstructive sleep apnea in a Primary Care Clinic. Research Updates In Medical Sciences 2(2): 70-4.
Schröder, C.M., O’Hara, R. 2005. Depression and obstructive sleep apnea (OSA). Ann Gen Psychiatry 4: 13.
Shpirer, I., Elizur, A., Shorer, R., Peretz, R.B., Rabey, J.M., Khaigrekht, M. 2012. Hypoxemia correlates with attentional dysfunction in patients with obstructive sleep apnea. Sleep Breath 16(3): 821-7.
Slater, G., Steier, J. 2012. Excessive daytime sleepiness in sleep disorders. J Thorac Dis 4(6): 608-16.
Somers, V.K., White, D.P., Amin, R., Abraham, W.T., Costa, F., Culebras, A., Daniels, S., Floras, J.S., Hunt, C.E., Olson, L.J., Pickering, T.G., Russell, R., Woo, M., Young, T. 2008. Sleep apnea and cardiovascular disease: an american heart association/american college of cardiology foundation scientific statement from the american heart association council for high blood pressure research professional education committee, council on. Circulation 118(10): 1080-111.
Stepnowsky, C., Sarmiento, K.F., Bujanover, S., Villa, K.F., Li, V.W., Flores, N.M. 2019. Comorbidities, health-related quality of life, and work productivity among people with obstructive sleep apnea with excessive sleepiness: findings from the 2016 Us National Health and Wellness Survey. J Clin Sleep Med 15(2): 235-43.
Stranks, E.K., Crowe, S.F. 2015. The cognitive effects of obstructive sleep apnea: an updated meta-analysis. Arch Clin Neuropsychol 31(2): 186-93.
Twigg, G.L., Papaioannou, I., Jackson, M., Ghiassi, R., Shaikh, Z., Jaye, J., Graham, K.S., Simonds, A.K., Morrell, M.J. 2010. Obstructive sleep apnea syndrome is associated with deficits in verbal but not visual memory. Am J Respir Crit Care Med 182(1): 98-103.
Waldman, L.T., Parthasarathy, S., Villa, K.F., Bron, M., Bujanover, S., Brod, M. 2020. Understanding the burden of illness of excessive daytime sleepiness associated with obstructive sleep apnea: a qualitative study. Health Qual Life Outcomes 18(1): 128.
Ward, K.L., Hillman, D.R., James, A., Bremner, A.P., Simpson, L., Cooper, M.N., Palmer, L.J., Fedson, A.C., Mukherjee, S. 2013. Excessive daytime sleepiness increases the risk of motor vehicle crash in obstructive sleep apnea. J Clin Sleep Med 9(10): 1013-21.
Yusoff, M.F., Baki, M.M., Mohamed, N., Mohamed, A.S., Yunus, M.R., Ami, M., Othman, I., Ishak, A.I. 2010. Obstructive sleep apnea among express bus drivers in malaysia: important indicators for screening. Traffic Inj Prev 11(6): 594-9.
