目的:大量研究表明阻塞性睡眠呼吸暂停(OSA)与抑郁症之间存在关联和症状重叠。然而,关于年龄之间关联的数据有限,性别,OSA诊断时抑郁症的严重程度,及其对PAP依从性的影响。患者健康问卷-9(PHQ-9)是DSM-5推荐的经过验证的抑郁筛查和严重程度评分工具。在这项回顾性观察研究中,我们评估OSA诊断时年龄之间的相互关系,抑郁症的严重程度,和气道正压通气(PAP)依从性。
方法:新诊断为OSA的患者,2022年2月至10月在加利福尼亚大学旧金山-弗雷斯诺睡眠中心进行了评估。抑郁严重程度的PHQ-9评分使用1-5量表(1=无,2=轻度,3=中度,4中度严重,5=严重)。在OSA诊断和随访时给予PHQ-9。在治疗开始的1至3个月之间从PAP装置获得平均每日PAP使用小时数。IBMSPSS29.0.0版用于计算描述性统计数据,皮尔逊相关性,和Mann-Whitney测试.
结果:77例患者符合纳入标准,其中28人为女性(36.4%)。平均基线AHI为34.5(S.D.31.8)。PHQ-9平均值为8.3,SD+/-5.9。在PHQ-9正常组和PHQ-9评分与抑郁一致的组(5分或更高)之间的MannWhitney比较显示AHI没有统计学上的显着差异(p=0.470),或平均夜间使用时间(p=0.195)。两组之间的年龄差异有统计学意义(p=0.031)。斯皮尔曼相关性证实为阴性,OSA患者PHQ-9评分与年龄之间有统计学意义的相关性。
结论:这项研究表明,OSA诊断时的PHQ-9评分与年龄较小,那些年龄小于50岁的患者比年龄较大的患者有更多的中度至重度抑郁评分。我们没有发现年龄与PAP依从性或PHQ-9评分与PAP依从性之间的相关性。我们的发现可以帮助在OSA的早期诊断中识别高风险抑郁症患者,并使人们意识到年轻的成年人群可能特别脆弱。
OBJECTIVE: Numerous studies have shown an association and symptom overlaps between obstructive sleep apnea (OSA) and depression. However, data are limited on the association between age, sex, the severity of depression at the time of OSA diagnosis, and its impact on positive airway pressure (
PAP) adherence. The Patient Health Questionnaire (PHQ-9) is a validated depression screening and severity scoring tool recommended by the Diagnostic and Statistical Manual of Mental Disorders (fifth edition). In this retrospective observational study, we evaluate the interrelationship between age at OSA diagnosis, depression severity, and
PAP adherence.
METHODS: Patients with new OSA diagnosis, seen at the University of California San Francisco-Fresno Sleep Center between February and October of 2022, were evaluated. PHQ-9 scores for depression severity uses a 1 to 5 scale (1 = none, 2 = mild, 3 = moderate, 4 moderately severe, 5 = severe). The PHQ-9 was administered at the time of OSA diagnosis and follow-up. Average daily
PAP usage hours were obtained from
PAP devices between 1 to 3 months after therapy initiation. IBM SPSS version 29.0.0 was used to calculate descriptive statistics, Pearson correlation, and Mann-Whitney test.
RESULTS: Seventy-seven patients fit the inclusion criteria, of which 28 were women (36.4%). The average baseline apnea-hypopnea index was 34.5 (standard deviation 31.8), with a PHQ-9 mean of 8.3 with standard deviation ± 5.9. A Mann-Whitney comparison between the group with normal PHQ-9 scores and the group with PHQ-9 scores consistent with depression (score of 5 or greater) showed no statistically significant differences in apnea-hypopnea index (P = .470) or average night hour use (P = .195). There was a statistically significant difference in age between both groups (P = .031). Spearman correlation confirmed a negative, statistically significant correlation between PHQ-9 scores and age in patients with OSA.
CONCLUSIONS: This study showed that PHQ-9 scores at the time of OSA diagnosis are moderately correlated with younger age, with those patients younger than 50 years old having more moderate to severe depression scores than older patients. We did not find a correlation between age and
PAP adherence or between PHQ-9 scores and
PAP adherence. Our findings can help identify high-risk depression patients early in the diagnosis of OSA and bring awareness that the young adult population can be particularly vulnerable.
BACKGROUND: Niraula R, Singh A, DelRosso LM, Meghpara S, Keenan L. Age matters: association between age and depression severity at the time of OSA diagnosis and
PAP adherence in adult patients. J Clin Sleep Med. 2024;20(6):859-862.