الفهرس 
Obstructive sleep apnoeaOnly 14 pages are availabe for public view
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Abstract
Obstructive sleep apnea (OSA) is a common sleep-related breathing disorder characterized by repetitive upper airway collapse during sleep, resulting in a complete (apnea) or partial (hypopnea) obstruction in airflow, reduced oxygen saturation levels which resulting in recurrent episodes of intermittent hypoxia leading to possible frequent interruption of sleep.
Anxiety and depressive symptoms are highly prevalent in patients with moderate to severe untreated OSA; however, the association of sleep apnea with anxiety and depression is not completely understood. Poor sleep quality and frequent arousals during sleep in OSA patients may affect mood. Moreover, intermittent hypoxemia that accompanies OSA has been proposed to influence mood.
Continuous positive airway pressure (CPAP) CPAP is considered the gold standard treatment modality as first-line for all OSA patients, because its use can improve sleep-related symptoms and quality of life. CPAP acts as a pneumatic splint that stabilizes the upper airway with constant positive pressure via a mask interface. Difficulty with CPAP may stem from mask discomfort or claustrophobia, pressure intolerance, lifestyle or social considerations, or a combination of these factors.
Obesity is the strongest predictor of OSA due to fat infiltration at the neck level, leading to upper airway collapse, and increased abdominal pressure, leading to lung volume reduction. Adipose tissue accumulation might also alter the neuro- mechanical control of the upper airway via the specific effects of leptin.
Weight loss has been recognized as an option for effective management of OSA. Weight loss has been demonstrated to reduce the volume of the lateral pharyngeal walls and pharyngeal fat pads, and this may contribute to the improvement in AHI and hence improving OSA.
The aim of the work was to assess anxiety and depression in patients with obstructive sleep apnea before and after 3 months from treatment with CPAP or weight reduction
The study included 40 patients diagnosed as OSA recruited from the Chest Department Menoufia University Hospitals in the period from November 2019 to November 2020, who were divided into two groups, group (1) included: 20 patients who were only with night CPAP for 3 months, group (2) included: 20 patients who were treated with weight reduction for 3 months.
Diagnosis of OSA and the degree of severity by complete overnight polysomnography (PSG).
Psychiatric symptoms were assessed using structured Clinical Interview of DSM IV (SCIDI ), Hamilton anxiety rating scale, Hamilton depression scale, Quality of life scale to assess effect of anxiety and depression symptoms on quality of life in obstructive sleep apnea patients. After 3months from treatment, all patients of both groups underwent repetition of Hamiliton’s anxiety and depression scales and Quality of life scale.
There were no significant differences regarding BMI, neck circumference and Epworth sleepiness scale between both groups before treatment. All patients in this study had the same clinical symptoms with significant difference in day time symptoms; patients in group (1) had a high significant difference in the tiredness and behavioral problems than those in group (2), but patients in group (2) had a high significant
Summary
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difference in drying mouth on awakening than patients in group (1). About night symptoms; patients in group (1) had a high significant difference in the frequent nocturia symptom than that in group (2). Patients in group (2) had a significant higher prevalence of DM than group (1). There were no significant differences in arterial blood gases between both groups. There were no significant differences between both groups as regarding polysomnographic parameters before treatment. There was significantly higher value of sleep efficiency and % of sleep in supine position during sleep among patients treated with CPAP (group1) after 3 months from treatment than before treatment. AHI, ODI and total arousal index lower among patients treated with CPAP (group1) after 3 months from treatment than before treatment, while there was no significant difference as regard TST, basal o2 saturation, flow limitation index, minimal o2 saturation and % of snoring index in TST. AHI, ODI and total arousal index during sleep were significantly of lower level in patients treated with Weight reduction (group2) after 3 months from treatment than before treatment. There were statistical significance differences concerning basal o2 saturation after 3 months from treatment than before treatment. There was significant lower level in BMI among patients in group (2) after 3 months from treatment than patients in group (1). There was statistically significance difference in patients treated with CPAP group (1) regarding grades of severity of OSA before and after 3 months from treatment, as before treatment with CPAP 40% of the patients had moderate OSA, 60% had severe OSA, while after 3 months from treatment with CPAP 50% from patients had mild OSA and 50% had moderate OSA. Also there was statistically significance difference in group (2) regarding grades of severity of OSA before and after 3 months from treatment, as before treatment 30% of the patients had moderate OSA and 70% had severe OSA, after 3 months from treatment 60% of the patients had mild OSA and 40% had moderate OSA. There was statistical significance decrease of AHI in both groups after 3 months from treatment than before treatment. There was statistically significant decrease of Hamilton Rating Scale for anxiety among patients in both groups after 3 months from treatment than before treatment. There was statistically significance decrease of Hamilton Rating Scale for depression among patients in both groups after 3 months from treatment than before treatment. There were improvements in the quality of life measures as regarding Ferrans and Powers Quality of life index pulmonary version - 11I in both groups after 3 months from treatment whether CPAP or weight reduction than before treatment.
CPAP treatment improved the symptoms of OSA and the degree of severity, as well as anxiety and depression associated and improved the quality of life.
Weight reduction therapy improved the symptoms of OSA and associated anxiety and depression and improved quality of life more than CPAP therapy as weight reduction improved mood.
However, patients with psychiatric co morbidity should get a psychiatric evaluation if the treatment of OSA does not result in mood improvement.