Nearly 73 percent of sleep apnea patients had clinical signs of depression, according to a new study published in the Journal of Sleep Medicine. The level of depression worsened with increasing sleep apnea severity.
However, only nine of 228 patients (4 percent) continued feeling depressed after three months of sleep apnea treatment. In fact, none of the people who previously reported suicidal thoughts were still depressed after undergoing sleep therapy. Researcher David R. Hillman MD said, “The findings highlight the potential for sleep apnea, a notoriously underdiagnosed condition, to be misdiagnosed as depression.”
The study was conducted by sleep physicians at the Sir Charles Gairdner Hospital in Perth. The group was comprised of 243 males and 183 female patients referred to the hospital sleep center for suspected sleep apnea. The mean age was 52 years. Depression was evaluated using a Patient Health Questionnaire and sleep apnea was gauged with an overnight polysomnography test in-lab. All told, 293 patients went on to receive sleep apnea treatment using Continuous Positive Airway Pressure (CPAP) therapy. Out of 293 patients, 228 adhered to the therapy for an average of five hours per night for three months.
Researchers concluded that it’s important to screen people with depression for sleep apnea. Symptoms like habitual snoring, breathing pauses and daytime fatigue are often overlooked by patients, but the American Academy of Sleep Medicine estimates that at least 25 million American adults are affected by the condition.
The CPAP therapy used in this study may have worked well for a short three month duration, but the reality is that many patients have trouble adhering to this therapy in the long-term. A 2008 article published in the Proceedings of the American Thoracic Society reported that 46 to 83 percent of patients were non-adherent to CPAP treatment, which was defined as greater than four hours of nightly use.
According to researchers, “the intrusive nature of CPAP therapy into the sanctity of the bedroom and the natural aversion to wearing unattractive headgear to bed have often been espoused as the reasons for nonadherence.” Furthermore, claustrophobia played a role for many patients, as a score greater than 25 on the modified Fear and Avoidance Scale predicted that patients were twice as likely to use CPAP for less than two hours a night.
By contrast to CPAP therapy, a 2004 study published in the Journal of Otolaryngology found that more than 50 percent of patients adhered to oral appliance therapy for more than 18 months. According to Sleep Review Magazine, oral appliance therapy “helps prevent the collapse of the tongue and soft tissues in the back of the throat by supporting the jaw in a forward position, keeping the airway open during sleep.”
It works for mild to moderate Obstructive Sleep Apnea (OSA) and can be used in conjunction with CPAP therapy as well. Half of all patients with severe sleep apnea have reported success with dental appliances as well. Patients with supine dependent OSA and craniofacial retrognathism are said to benefit most. While 90 percent of patients show excellent results from oral appliance therapy, it may not be the best treatment for the morbidly obese or patients with poor dental health.
The process is simple. After receiving a referral from a sleep doctor or primary physician, Dr. David Blaustein will perform an oral examination, take x-rays, and discuss pros and cons of the treatment. If you are a good candidate, he’ll take impressions of the teeth and create a custom-made mouthpiece that keeps the mouth in a neutral, slightly open position during sleep. Small adjustments may be necessary to ensure a perfect fit and a subsequent sleep test to determine efficacy may be required in the coming weeks.
Best of all, most insurance providers cover the cost! Call Chelsea Dental Aesthetics at 347-973-7527 for an inexpensive, effective solution to alleviate sleep apnea and associated depression.
