Does surgery for obstructive sleep apnea improve depression and sleepiness?
OBJECTIVE
To determine if surgical intervention for OSA (obstructive sleep apnea), particularly multilevel surgery, decreases depression and sleepiness.


METHODS
Prospective cohort study.


METHODS
Chart and prospective outcome database review of patients who underwent surgery from August 2008 through November 2012. Patients were evaluated before and after surgery using the Epworth Sleepiness Scale (ESS), the Beck Depression Index (BDI), and overnight polysomnography.


RESULTS
Forty-four patients (12 females; 32 males) met inclusion criteria. Mean age of participants was 44.0 years (SD, 10.2); mean body mass index was 31.9 (SD, 9.3). The mean preoperative obstructive respiratory disturbance index (RDI) was 35.8 events/hour (SD, 21.9; range, 6.6-94.2), which decreased to 17.1 (SD, 19.5; range, 0.8-78.1; P < 0.0001). Mean ESS improved from 10.8 (SD, 4.7) to 6.3 (SD, 3.7; P = 0.0001); whereas BDI scores improved from 8.4 (SD, 8.2) to 4.9 (SD, 6.0; P = 0.0051). There were 22 (50.0%) patients with excessive daytime sleepiness and 12 (27.3%) patients with depression before surgery. Surgery was associated with resolution of sleepiness in 17 patients (77.3%) and depression in 9 patients (75.0%). In multivariable regression analysis, only change in ESS (P = 0.003) and baseline BDI (P < 0.001) were associated with improvement in depression. RDI was not significant (P = 0.15).


CONCLUSIONS
Surgical treatment of OSA, especially multilevel surgery, resulted in significantly reduced depression, with resolution in 75% of patients. Similarly, surgery resulted in significantly reduced sleepiness, with resolution in 77% of patients. Reduction in sleepiness scores, but not OSA severity, was predictive of improvement in depression scores. Further evaluation with a larger sample size and a control group is warranted.


METHODS
4.
Department of Otolaryngology-Head and Neck Surgery, University of Cincinnati College of Medicine, Cincinnati, Ohio; Divisions of Pediatric Otolaryngology & Pulmonary Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.
Stacey L
SL
Ishman
James R
JR
Benke
Aliza P
AP
Cohen
Matthew J
MJ
Stephen
Lisa E
LE
Ishii
Christine G
CG
Gourin
D000328:Adult; D000368:Aged; D015992:Body Mass Index; D003863:Depression / Q000175:diagnosis / Q000209:etiology* / Q000503:physiopathology; D006970:Disorders of Excessive Somnolence / Q000175:diagnosis / Q000209:etiology* / Q000503:physiopathology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D017286:Polysomnography; D011446:Prospective Studies; D011594:Psychometrics; D012720:Severity of Illness Index; D012890:Sleep / Q000502:physiology*; D020181:Sleep Apnea, Obstructive / Q000150:complications / Q000175:diagnosis / Q000601:surgery*; D016896:Treatment Outcome; D055815:Young Adult
Beck Depression Inventory; Epworth Sleepiness scale; depression; obstructive sleep apnea; sleepiness; surgery