title: Depressive symptoms before and after long-term CPAP therapy in patients with sleep apnea.
abstract: BACKGROUND
  The outcome of depressive symptoms under CPAP therapy for OSA-hypopnea syndrome (OSAHS) has been poorly evaluated. In this multicenter, prospective cohort study, we evaluated the prevalence and correlates of persistent depressive symptoms after long-term CPAP therapy for OSAHS.
  
  
  METHODS
  This study included 300 patients with OSAHS and depressive symptoms (13-item, self-rated Pichot depression scale [QD2A] ≥ 7) at diagnosis. The primary dependent variable was persistent depressive symptoms after ≥ 1 year of CPAP therapy. Multivariate regression analyses were performed to determine variables independently associated with the persistence of depressive symptoms.
  
  
  RESULTS
  After an average of 529 days (range, 365-1,569 days) of CPAP therapy, the mean (SD) QD2A score decreased from 9.2 (2.0) to 5.4 (4.0) (P &lt; .0001), but 125 patients (41.7%) presented persistent depressive symptoms. The persistence of depressive symptoms was independently associated with persistent excessive daytime sleepiness (EDS) (OR, 2.72; 95% CI, 1.33-5.61), comorbid cardiovascular disease (OR, 1.76; 95% CI, 1.02-3.00), and female sex (OR, 1.53; 95% CI, 1.09-2.13). A positive linear trend was observed for the adjusted OR of persistent depressive symptoms with decreasing CPAP effect on the Epworth sleepiness scale (P &lt; .0001).
  
  
  CONCLUSIONS
  CPAP therapy does not resolve depressive symptoms in many patients with OSAHS. Persistent depressive symptoms are strongly associated with EDS. Active monitoring of depressive symptoms is needed in patients with OSAHS who are treated with CPAP. Interventional trials are required to evaluate the impact of antidepressants, cognitive behavioral therapy, or both on comorbid depression in patients with OSAHS.
authors.affiliation: LUNAM Université, Angers; Université d'Angers, CHU Angers, Département de Pneumologie, Angers. Electronic address: frgagnadoux@chu-angers.fr.
authors.forename: Frédéric
authors.initials: F
authors.lastname: Gagnadoux
authors.affiliation: CERMES, CNRS UMR8211 - Inserm U988 - EHESS, Villejuif.
authors.forename: Marc
authors.initials: M
authors.lastname: Le Vaillant
authors.affiliation: Centre Hospitalier, Service de Pneumologie, Le Mans.
authors.forename: François
authors.initials: F
authors.lastname: Goupil
authors.affiliation: Pôle santé des Olonnes, Unité de Pneumologie, Olonne sur Mer.
authors.forename: Thierry
authors.initials: T
authors.lastname: Pigeanne
authors.affiliation: Institut du Thorax, Pneumologie, Hôpital Laennec, Nantes.
authors.forename: Sylvaine
authors.initials: S
authors.lastname: Chollet
authors.affiliation: Centre Hospitalier, Service de Pneumologie, Cholet.
authors.forename: Philippe
authors.initials: P
authors.lastname: Masson
authors.affiliation: Centre Hospitalier, Service de Pneumologie, La Roche sur Yon.
authors.forename: Acya
authors.initials: A
authors.lastname: Bizieux-Thaminy
authors.affiliation: Nouvelles Cliniques Nantaises, Pneumologie, Nantes, France.
authors.forename: Marie-Pierre
authors.initials: MP
authors.lastname: Humeau
authors.affiliation: LUNAM Université, Angers; Université d'Angers, CHU Angers, Département de Pneumologie, Angers.
authors.forename: Nicole
authors.initials: N
authors.lastname: Meslier
mesh_terms: D045422:Continuous Positive Airway Pressure / Q000379:methods*; D003863:Depression / Q000175:diagnosis / Q000453:epidemiology* / Q000209:etiology; D005260:Female; D005500:Follow-Up Studies; D005602:France / Q000453:epidemiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D010349:Patient Compliance; D015995:Prevalence; D011446:Prospective Studies; D011788:Quality of Life; D012891:Sleep Apnea Syndromes / Q000150:complications / Q000503:physiopathology / Q000628:therapy*; D012894:Sleep Stages / Q000502:physiology*