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Sleep Apnea Articles:
Sleep Apnea Equipment and Appliances
Depression and Obstructive Sleep
Apnea
Sleep Apnea, and Overview
Natural Sleep Aids
Obesity and Sleep Apnea
Obstructive Sleep Apnea
Sleep Paralysis
Sleep Aids
What Causes Sleep Apnea?
Common Symptoms of Sleep
Apnea
Other Sleep Disorders
What Is a Sleep Study Like?
Surgical Treatments
for Sleep Apnea
Can Sleep Apnea Cause Death?
Adjustable Beds for Sleep Apnea |
Screening
Depressed Patients for OSA
< Continued from page 2
Compared to the large number of studies investigating depressive
symptomatology in OSA patients, far fewer studies have focused
on the screening for OSA in a primarily depressed study population.
In one of the few investigations of the prevalence of OSA in
a depressed cohort, Reynolds et al. found, in a small sample of
17 older patients with major depression, that 17.6% also had an
OSA syndrome, compared to 4.3% of 23 healthy elderly controls
.
This suggests that OSA might be an important confounding factor
for studies on mood disorders in general, as its presence is not
routinely determined in either research studies examining mood
or clinical settings. However, many more studies are required
to assess the prevalence of OSA in primarily depressed patients,
particularly as it can be suspected from existing studies that
OSA is greatly underdiagnosed in this patient population.
Clinically, this is of particular concern, as sedative antidepressants
and adjunct treatments for depression may actually exacerbate
OSA. Notably hypnotics prescribed to treat depression-related
insomnia might further decrease the muscle tone in the already
functionally impaired upper airway dilatator muscles, blunt the
arousal response to hypoxia and hypercapnia as well as increase
the arousal threshold for the apneic event, therefore increasing
the number and duration of apneas .
These effects might differ depending on the patient population
and the severity of OSA. Older depressive subjects are of primary
concern: both, frequency of OSA and depressive symptoms increase
with age, as do prescription and consumption of sedative psychotropic
medication. Pharmacologic treatment of depression and depression-related
insomnia in this age group should therefore routinely consider
the potential presence of a concomitant OSA.
Finally, as Baran and Richert point out, the diagnosis of a mood
disorder in the presence of OSA has its very own challenges .
Considering the DSM-IV definitions , it could either be viewed
as a mood disorder due to a general medical condition, or classified
as an adjustment disorder with depressed mood, due in particular
to EDS and its debilitating consequences on the patients' daytime
functioning. The identification of pathophysiological features
that allow distinction between OSA and depression might assist
with such diagnostic issues.
Neurobiology of depression and upper airway control in OSA:
the role of serotonin
The high comorbidity of OSA and depression suggests that both
disorders may share a common neurobiological risk factor. On the
neurotransmitter level, the serotoninergic system has a central
role as a neurobiological substrate underlying impairments in
the regulations of mood, sleep-wakefulness cycle, and upper airway
muscle tone control during sleep. Depression is associated with
a functional decrease of serotoninergic neurotransmission, and
is mostly responsible for the alterations in sleep as outlined
above .
The physiopathology of OSA involves numerous factors, among whose
the abnormal pharyngeal collapsibility during sleep is one of
the most compelling. Serotonin delivery to upper airway dilatator
motor neurons has been shown to be reduced in dependency of the
vigilance state .
This leads to reductions in dilator muscle activity specifically
during sleep, which may contribute to sleep apnea. However, whereas
the role of serotonin in mood disorders has been largely documented,
its involvement in the pathophysiology of sleep apnea remains
to be clarified. Interestingly, molecules increasing 5-HT neurotransmission
such as the Serotonin reuptake inhibitors (SSRI) are widely prescribed
antidepressant molecules that are suggested to similarly improve
the apnea hypopnea index in OSA.
Serotoninergic drugs such as fluoxetine, protryptiline and paroxetine
have already been tested for OSA, with limited success and numerous
adverse effects . Several 5-HT receptor ligands and bi-functional
molecules are under development, which may in the future be able
to target both, the depressive syndrome and OSA.
Continued on page 4 - Depression and
Sleep Apnea - Shared Risk Factors >
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