Anxiety and depressive symptoms on continuous positive airway pressure: long-term adherence in patients with sleep apnea syndrome

BACKGROUND: Obstructive sleep apnea (OSA) is often associated to mood disorders and anxiety symptoms that may influence negatively the treatment approach. However, the relationship between anxiety, depression and adherence to treatment is still unclear. We investigate the presence of anxiety and depressive symptoms in newly diagnosed OSA patients and the link between psychological symptoms and acceptance or adherence to CPAP after one year. METHODS: A validated Italian questionnaire for anxiety and depressive symptoms was administered to 249 patients (69F) with a mean age of 57.2 +/- 12.2 and a mean AHI of 40.9 +/- 21.9 (ev*hr-1). The CPAP use in the first and last night of acclimatization and one year after prescription was 6.4 +/- 2.2, 6.9 +/- 1.4 and 5.3 +/- 2.2 hr, respectively. RESULTS: Anxiety symptoms were reported by 15.6% of patients, depressive symptoms by 6% while 12.5% reported both anxiety and depressive symptoms. Adherence to CPAP in the first night was not adequate in 19.7% of patients with relevant difference between groups: 16.4% in AD-,20.5% in A+,13.3% in D+ and 38.7% in AD+ (.2=8.6; P=0.03). However, at the end of acclimatization period only 4.4% of patients utilized CPAP<5/h. One-year after prescription the adherence was adequate in 74.7% of patients without difference between groups. A Cox proportional hazard model demonstrated that AHI (OR=0.985, 95% CI: 0.97-0.99; P=0.03) and compliance to CPAP at the first night of use (OR=0.445; 95% CI: 0.246-0.8; P=0.007) are the only predictive factors of long-term compliance. CONCLUSIONS: Presence of anxiety and depressive symptoms should be checked before PAP titration since they may negatively influence the early acclimatization and adherence.

Automated summary

This study investigated the presence of anxiety and depressive symptoms in OSA patients and the link between these psychological symptoms and acceptance or adherence to CPAP treatment. The results suggested that anxiety and depression may negatively influence early acclimatization and adherence to treatment.