Obstructive sleep apnea syndrome. Treatment outcome, psychiatric aspects, neuropsychology and quality of life

Abstract

Background: Obstructive sleep apnea syndrome (OSAS) is characterized by snoring and apneas during sleep leading to oxygen desaturation, sleep fragmentation and excessive daytime sleepiness. Prior reports have indicated that psychiatric morbidity associated with sleep apnea might be reversed by intervention correcting the sleep related breathing disorder.Participants and methods: Fifty-three unselected consecutive patients with OSAS underwent a five year prospective study, before and after surgery with uvulopalatopharyngoplasty (UPPP), of standardized sleep recordings, psychiatric morbidity, quality of life and neurocognitive function. Thirty-two couples (patients and their spouses) were investigated concerning changes in psychosocial and marital adjustment. Results: Preoperatively, eighteen patients (34%) fulfilled DSM criteria for a depressive disorder, 98% had hypersomnia and fourteen patients, 25%, were non-suppressors of the dexamethasone suppression test. The patients spouses were also affected regarding their mental health and quality of life (QoL). Six months postoperatively only 10% of the patients fulfilled criteria for a depressive disorder and 6% had hypersomnia. Four patients did not suppress plasma cortisol. Surgery also resulted in a significant reduction of the oxygen desaturation index (ODI) and an increase of minimum SaO2. Furthermore there were significant improvements in verbal learning and memory, recall and executive functioning. These improvements were in parallel with indications of better oxygenation. Spouses psychic health also improved significantly at six months follow-up, parallel with significant improvements in their QoL. Forty-eight patients completed the five years follow-up. Need for additional treatment with continuous positive airway pressure (CPAP) was seen in 31% of the patients leaving thirty-three patients for evaluation. Even if the number of depressed patients and the total score of psychopathological symptoms were back to the same level as baseline. A substantial proportion (41%), n=22, seemed to benefit from surgery after five years according to a composite outcome index based on subjective as well as objective measures. Conclusion: It is concluded that depressive disorder is common in OSAS patients. Sleep apnea may be considered as a possible alternative or a concomitant diagnosis in mood disorders. Surgical treatment seems to decrease psychiatric morbidity and to improve cognitive functions in parallel with better oxygenation. Even though relapse in disease severity improvement in mental health was still evident in 41% five years after surgery. Treatment of OSAS is also important preventing collateral damage in partners.