Highlights
- •Many symptoms of obstructive sleep apnea and depression overlap.
- •Causal association between the conditions has been suggested but is poorly understood.
- •Information is limited in terms of both quality and quantity and mixed outcomes are reported.
- •High-quality studies are needed to clarify the true nature of this association.
Abstract
Introduction
The present study aimed to review the association between obstructive sleep apnea
(OSA) and depression and compare the prevalence of depression among people with and
without OSA.
Methods
Systematic review and meta-analysis following PRISMA guidelines. We searched for papers
published between 1 January 2010 and 20 October 2019 listed on the following databases:
Embase, Ovid MEDLINER(R) and PsychINFO. The search terms included a combination of
keywords related to sleep apnea and depression. We also completed a manual search
of the references listed in the articles retrieved and grouped them according to study
design: cross-sectional, case-control and longitudinal. Scale scores were standardised
for comparison.
Results
Our search strategy yielded 1158 papers, of which 34 were considered suitable of review
and 11 reported data that could be used for meta-analysis. Data from the 6 cross-sectional
studies found no compelling evidence of an association between OSA and depression
(odds ratio = 1.12, 95 % confidence interval, 95 %CI = 0.78, 1.47), but the meta-analysis
of 5 longitudinal studies indicated that people with OSA were at greater risk of developing
depression during follow-up than those without OSA (non-specific risk ratio (RR) =
2.18, 95 %CI = 1.47, 2.88), although there was evidence of high study heterogeneity
(I2 = 72.8 %).
Discussion
The results of this systematic review and meta-analysis of observational studies is
consistent with the hypothesis that OSA may increase the risk of depression. Sample
characteristics and various methodological issues create uncertainty about the validity
and generalizability of these associations.
Keywords
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Article info
Publication history
Published online: June 07, 2020
Accepted:
June 4,
2020
Received in revised form:
May 28,
2020
Received:
April 29,
2020
Identification
Copyright
© 2020 Elsevier B.V. All rights reserved.
