Should Patients with Obstructive Sleep Apnea Be Screened for Depression?

TRIO Best Practice articles are brief, structured reviews designed to provide the busy clinician with a handy outline and reference for day-to-day clinical decision making. The ENTtoday summaries below include the Background and Best Practice sections of the original article. To view the complete Laryngoscope articles free of charge, visit Laryngoscope.

Background

Screening patients for comorbid diseases is critical to comprehensive patient care. It is well established that patients with obstructive sleep apnea (OSA) have an increased prevalence of depression, yet screening is not yet routine. Recognizing and addressing symptoms of depression may have a multifaceted positive impact on these patients, including improved quality of life, reduced psychosocial disease burden, and improved compliance with patient-motivated management strategies such as continuous positive airway pressure (CPAP) and weight loss. Thus, undiagnosed depression can lead to untreated OSA and progression of cardiovascular disease. This raises the question of whether it is worthwhile to screen patients with OSA for depression.

Best Practice

Screening for depression in patients with OSA would be worthwhile because there is a high rate of comorbidity, and both are intertwined in their pathophysiology and management. Clinicians should pay special attention to high-risk populations such as those who are more sleepy, single, have more severe OSA and hypoxia, or have reduced family or social supports. Once identified, there is evidence to support that management of OSA can reduce depression. This has important implications for patient education in describing the benefits of OSA interventions. Future research should examine the impact of psychiatric treatment of depression on OSA, or the effect of surgical OSA treatment on depression (Laryngoscope. 2019;129:1729-1730).