title: Comorbid depression in obstructive sleep apnea: an under-recognized association.
abstract: BACKGROUND
  Obstructive sleep apnea (OSA) and depression may coexist in the same patient. This article aims to review the link between OSA and comorbid depression and critically evaluate the results of studies that assessed the correlation between OSA and depression, the impact of OSA treatment on comorbid depression, and the impact of comorbid depression on continuous positive airway pressure (CPAP) adherence.
  
  
  METHODS
  An integrative review was conducted on English language studies and reports that assessed the relationship between OSA and depression. Studies were identified by searching PubMed, Web of Science and Google Scholar databases, and reference lists of included studies.
  
  
  RESULTS
  Generally, cross-sectional studies show a higher prevalence of depression among OSA patients with both community and sleep disorder clinic samples. Nevertheless, the relationship between OSA and depression is complicated by the fact that the disorders have overlapping symptoms. Longitudinal studies demonstrate an increased risk of developing depression among people with OSA, as well as an association between OSA severity and the likelihood of developing depression. On the other hand, studies assessing the impact of CPAP therapy on depression among OSA patients report conflicting results. Therefore, it is essential to consider how the disorders affect one another and to understand the clinical consequences of treating each disorder in isolation.
  
  
  CONCLUSIONS
  Depression is prevalent among patients with OSA both in the community and in sleep disorder clinics. Clinicians in general should be aware of this significant association and should aim to treat both disorders.
authors.affiliation: The University Sleep Disorders Center, Department of Medicine, College of Medicine, King Saud University, Box 225503, Riyadh, 11324, Saudi Arabia. ashammam2@gmail.com.
authors.forename: Ahmed S
authors.initials: AS
authors.lastname: BaHammam
authors.affiliation: Institute for Clinical Evaluative Science, Sunnybrook Health Sciences Center, Toronto, ON, Canada.
authors.forename: Tetyana
authors.initials: T
authors.lastname: Kendzerska
authors.affiliation: Department of Psychiatry & Sleep Clinic, Himalayan Institute of Medical Sciences, Swami Ram Nagar, Doiwala, Dehradun, India.
authors.forename: Ravi
authors.initials: R
authors.lastname: Gupta
authors.affiliation: M.S. Chellamuthu Trust and Research Foundation, K.K. Nagar, Madurai, 625 002, India.
authors.forename: Chellamuthu
authors.initials: C
authors.lastname: Ramasubramanian
authors.affiliation: Department of Psychiatry and Behavioral Science, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
authors.forename: David N
authors.initials: DN
authors.lastname: Neubauer
authors.affiliation: Department of Neuropsychiatry and Behavioral Science, University of South Carolina School of Medicine, Columbia, SC, USA.
authors.forename: Meera
authors.initials: M
authors.lastname: Narasimhan
authors.affiliation: Somnogen Canada Inc., College Street, Toronto, ON, M6H 1C5, Canada.
authors.forename: Seithikurippu R
authors.initials: SR
authors.lastname: Pandi-Perumal
authors.affiliation: Sleep and Fatigue Institute, The University of Calgary, 922 5th Ave SW, #518, Calgary, Alberta, T2P 5R4, Canada.
authors.forename: Adam
authors.initials: A
authors.lastname: Moscovitch
mesh_terms: D015897:Comorbidity; D045422:Continuous Positive Airway Pressure / Q000523:psychology; D003430:Cross-Sectional Studies; D003866:Depressive Disorder / Q000175:diagnosis* / Q000453:epidemiology* / Q000523:psychology / Q000628:therapy; D006801:Humans; D008137:Longitudinal Studies; D010349:Patient Compliance / Q000523:psychology; D012307:Risk Factors; D020181:Sleep Apnea, Obstructive / Q000175:diagnosis* / Q000453:epidemiology* / Q000523:psychology / Q000628:therapy; D013223:Statistics as Topic
keywords: CPAP; Depression; Obstructive sleep apnea