Does surgical intervention, particularly multilevel surgery, for obstructive sleep apnea (OSA) decrease depression and sleepiness?
Background: Previous studies have reported a consistent association between OSA and depression. Associations between sleepiness and sleep-related conditions have been well documented. Sleepiness has not always been a reliable clinical indicator for OSA but has been an independent risk factor associated with depression. The impact of multilevel surgery on depression has not been investigated.
Explore This IssueDecember 2014
Study design: Prospective cohort study of 44 patients who underwent surgery between August 2008 and November 2012.
Setting: Department of Otolaryngology–Head and Neck Surgery, Johns Hopkins Medical Institutions, Baltimore.
Synopsis: Forty patients had moderate or severe OSA, while four patients had mild disease. Single-level surgery was performed in 11 patients; the remaining 33 underwent either two- or three-level surgery. Overall, oropharyngeal surgery was performed in 41 patients, tongue or hypopharynx surgery was performed in 31 patients, and nasal surgery was performed in conjunction with palatal or tongue-base surgery in 16 patients. Surgery relieved depression in nine of 12 patients. There was a significant decrease in Beck Depression Inventory scores in patients who underwent two- or three-site surgery; patients who underwent single-site surgery showed no decrease.
None of the six patients with mild OSA experienced depression. OSA surgery was associated with sleepiness resolution in 17 of 22 patients. There was a significant decrease in Epworth Sleepiness Scale scores in patients who underwent two- or three-site surgery; patients who underwent single-site surgery showed no decrease.
Limitations of the study include a selection bias favoring more severe symptoms, lack of a control group, and a possible underestimation of depression changes due to an early follow-up.
Bottom line: Multilevel OSA surgery resulted in significantly reduced depression (with resolution in 75% of patients) and significantly reduced sleepiness (resolution in 77% of patients). Sleepiness score reduction, but not OSA severity, was predictive of depression score improvement.