Predictors of anxiety and depression in patients with obstructive sleep apnea

Several studies have investigated the association of obstructive sleep apnea syndrome [OSAS] with depression and anxiety; however, the relationship is still poorly understood. Therefore, we aimed to assess anxious and depressive symptoms in OSA, and evaluate their association with potentially related variables of OSAS. This study included 72 patients newly diagnosed with obstructive sleep apnea and 30 controls. Patients underwent an overnight polysomnography and were assessed using the Epworth sleepiness scale [ESS] for excessive daytime sleepiness [EDS], hospital anxiety and depression scale [HAD] for anxious and depressive symptoms, and Maugeri obstructive sleep apnea syndrome [MOSAS] questionnaire for quality of life [QOL]. 72 OSA patients [60 men and 12 women] whose mean age was 48.8 +/- 11.73 yr and mean apnea and hypopnea index [AHI] was 64 +/- 21.86, were compared with 30 controls according to their HAD scores. We found that the HAD score for anxiety and depression was higher in OSA patients than in the control group [p = 0.001 and 0.002 respectively]. Moreover, the prevalence of symptoms of anxiety in patients with OSA was 33% while that of depression was 51%. Linear regression analysis revealed that daytime sleepiness and reduced QOL were strong predictors of depressive symptoms in OSA patients [P = 0.001 and 0.002 respectively], while reduced QOL was the only predictor of anxious symptoms [p = 0.035]. No significant relations were found between severity of psychological symptoms and AHI or nocturnal hypoxemia in OSA patients. Anxious and depressive symptoms are highly prevalent in patients with moderate to severe untreated OSAS. The severity of depressive symptoms maybe more related to excessive daytime sleepiness than to nocturnal hypoxemia. The reduced QOL is a strong predictor of psychiatric symptoms in OSAS patients. Therefore, patients with OSAS should be routinely screened for psychiatric symptoms to improve QOL and optimize diagnosis and therapy in these patients

Sleep-related breathing disorders in patients with Schistosomal cor-pulmonale

Schistosmiasis has long been an endemic disease in Egypt and an important cause of pulmonary hypertension. We aimed to investigate the clinical and polysomnographic features of sleep-related breathing disorders [SRBD] in patients with schistosomal cor-pulmonale and to evaluate their effects on pulmonary hemodynamics. We studied 10 stable patients diagnosed with schistosomal pulmonary hypertension [7 males and 3 females their mean age was 43.7 +/- 8.04] and 10 healthy volunteers matched for age, sex and BMI. Patients' exclusion criteria were: smoking, morbid obesity, other secondary causes of pulmonary hypertension, systemic hypertension, ischemic or rheumatic heart disease or left heart failure. All patients underwent overnight polysomnography or ambulatory cardiorespiratory sleep studies, spirometry, ECG and echocardiography. Daytime sleepiness was also assessed using the Epworth sleepiness scale [ESS]. The mean AHI in patients group was 20.0 +/- 11.34/h while in the control group it was 2.3 +/- 1.16/h. 80% of the patients were found to have an AHI > 10/h and 60% had moderate to severe sleep apnea [AHI >/= 15/h]. In addition, the majority of the patients [80%] spent > 30% of the night with an arterial oxygen saturation <90%. SRBD were not correlated with anthropometric measures, spirometry nor with the typical symptoms of SA such as excessive sleepiness as assessed by ESS. More importantly, SRBD were significantly associated with measures of pulmonary hypertension severity, and patients with moderate to severe SA had more impaired cardiovascular function as indicated by more severe right ventricular dilatation [p = 0.036] than patients with mild sleep apnea. SRBD are highly prevalent in patients with schistosomal pulmonary hypertension [PH]. Also, the SA severity was correlated with more advanced PH and more severe cardiovascular impairment. Therefore in the evaluation of patients with schistosomal PH, polysomnography or an ambulatory cardiorespiratory sleep study seems justified to identify potentially treatable SRBD that may additionally challenge the already compromised cardiovascular system in these patients

Sleep apnea in kidney transplant patients: clinical correlates and comparison with pretransplant patients

Sleep disordered breathing [SDB] is a prevalent, but forgotten, cardiovascular [CV] risk factor in end-stage renal disease patients. Studies of SDB in renal transplant patients are few with mixed results. To assess the prevalence and clinical correlates of SA in patients who received a kidney transplant, and to compare the prevalence of SA between waiting list and transplant patients. Our study included 40 clinically stable renal transplant patients and 15 patients awaiting transplantation. Patients with morbid obesity, diabetes, pulmonary disease or symptomatic heart failure were excluded from the study. All patients underwent overnight polysomnography, demographic and clinical data were also collected. We found that the prevalence of SA was high in both the transplant and the waiting list groups [38% vs 47%]. The severity of SA didn't show significant difference in both groups [AHI = 9.6 vs 16.2]. Moreover, we found a significant association between impaired renal function and the AHI in Tx patients. Also, SA was associated with difficult-to-treat hypertension in Tx patients as we found a significant association between the AHI and the systolic blood pressure as well as the number of prescribed antihypertensive drugs. SA is as highly prevalent in Tx as in WL patients. Moreover, this high prevalence in the transplant patients could be a consequence of declining renal function. In addition, we propose that sleep apnea is a new risk factor for hypertension and cardiovascular events in kidney-transplanted patients