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.
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.