The impact of CPAP therapy on depressive symptom scores, emotional regulation and reactivity in OSA patients_Chinese Journal of Respiratory and Critical Care Medicine

Authors：

DUAN Xuebo ¹ , CAI Yongli ² ,  LI Fang ³

1. Department of Respiratory and Critical Care Medicine, People’s Hospital of Ningxia Hui Autonomous Region, Ningxia Medical University, Yinchuan, Ningxia 750004, P. R. China;
2. Clinical Medical College of Ningxia Medical University, Yinchuan, Ningxia 750004, P. R. China;
3. Department of Respiratory and Critical Care Medicine, General Hospital of Ningxia Medical University, Yinchuan, Ningxia 750004, P. R. China;

Corresponding?author：

LI Fang, Email: fangli2008@live.com

Keywords：

Obstructive sleep apnea; continuous positive airway pressure; depression; emotional response; emotion regulation difficulties

DOI：

10.7507/1671-6205.202504013

Video：

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Objective To evaluate the changes in depressive symptoms and emotional responses in obstructive sleep apnea (OSA) patients after six months of continuous positive airway pressure (CPAP) therapy. Methods From June 2021 to December 2023, adult patients diagnosed with OSA at our hospital who were recommended for CPAP therapy as a first-line treatment were recruited. Demographic data (age, body mass index, gender), oxygen desaturation index, maximum duration of apnea and maximum duration of apnea were recorded. The patients were divided into a CPAP group and a non-CPAP group according to whether they were compliant to CPAP treatment. All patients completed questionnaires (including CES-D, DERS, ERS, and ESS) at 0, 1, 2, 4, and 6 months. Differences in general data and questionnaire results were compared between the two groups. Results The patients in the CPAP group showed significantly lower levels of depression and daytime sleepiness at 1, 2, 4, and 6 months compared with the non-CPAP group, with statistically significant differences (all P<0.05). Additionally, the CPAP group exhibited significantly lower scores in emotional responses and difficulties in emotion regulation across the same time points, with statistically significant differences (all P<0.05). In the non-CPAP group, increases in the apnea hypopnea index (AHI) and worsening emotional responses were key factors contributing to the exacerbation of depressive symptoms in OSA patients, with statistically significant differences (P<0.05). Conclusions CPAP therapy significantly improves depressive symptoms, emotional responses, and emotional regulation in OSA patients. Increases in the AHI and worsening emotional responses are primary factors leading to the worsening of depressive symptoms in OSA patients.

Citation： DUAN Xuebo, CAI Yongli, LI Fang. The impact of CPAP therapy on depressive symptom scores, emotional regulation and reactivity in OSA patients. Chinese Journal of Respiratory and Critical Care Medicine, 2025, 24(11): 767-774. doi: 10.7507/1671-6205.202504013 Copy

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2.	Guglielmi O, Sanchez AI, Jurado-Gamez B, et al. Obesity and sleep quality: the predictors of depression and anxiety in obstructive sleep apnea syndrome patients. Revista de neurologia, 2011, 52(9): 515-521.
3.	Harris M, Glozier N, Ratnavadivel R, et al. Obstructive sleep apnea and depression. Sleep Med rev, 2009, 13(6): 437-444.
4.	Ong JC, Gress JL, San Pedro-Salcedo MG, et al. Frequency and predictors of obstructive sleep apnea among individuals with major depressive disorder and insomnia. Psychosom Res, 2009, 67(2): 135-141.
5.	Saunam?ki T, Jehkonen M. Depression and anxiety in obstructive sleep apnea syndrome: a review. Acta Neurol Scand, 2007, 116(5): 277-288.
6.	Jackson ML, Tolson J, Bartlett D, et al. Clinical depression in untreated obstructive sleep apnea: examining predictors and a meta-analysis of prevalence rates. Sleep Med, 2019, 62: 22-28.
7.	Nadeem R, Molnar J, Madbouly, et al. Serum inflammatory markers in obstructive sleep apnea: a meta-analysis. J Clin Sleep Med, 2013, 9: 1003-1012.
8.	Bozic J, Borovac JA, Galic T, et al. Adropin and inflammation biomarker levels in male patients with obstructive sleep apnea: a link with glucose metabolism and sleep parameters. J Clin Sleep Med, 2018, 14(7): 1109-1118.
9.	Aikens JE, Caruana-Montaldo B, Vanable PA, et al. MMPI correlates of sleep and respiratory disturbance in obstructive sleep apnea. Sleep, 1999, 22(3): 362-369.
10.	Reyes-Zuniga M, Castorena -Maldonado A, Carrillo -Alduenda JL, et al. Anxiety and depression symptoms in patients with sleepdisordered breathing. Open Respir Med J, 2012, 6(1): 97-103.
11.	倪明, 岳偉華, 劉破資. 睡眠呼吸暫停低通氣綜合征患者的抑郁焦慮癥狀研究. 中國臨床心理學雜志, 2004, 12(2): 192-193.
12.	Bardwell WA, Norman D, Ancoli-Israel S, et al. Effects of 2-week nocturnal oxygen supplementation and continuous positive airway pressure treatment on psychological symptoms in patients with obstructive sleep apnea: a randomized placebo-controlled study. Behav Sleep Med, 2007, 5(1): 21-38.
13.	Cross RL, Kumar R, Macey PM, et al. Neural alterations and depressive symptoms in obstructive sleep apnea patients. Sleep, 2008, 31(8): 1103-1109.
14.	中華醫學會, 中華醫學會雜志社, 中華醫學會全科醫學分會, 中華醫學會呼吸病學分會睡眠呼吸障礙學組, 中華醫學會《中華全科醫師雜志》編輯委員會, 呼吸系統疾病基層診療指南編寫專家組. 成人阻塞性睡眠呼吸暫停基層診療指南(2018年). 中華全科醫師雜志, 2019, 18(1): 21-29.
15.	Radloff LS. The CES-D scale: a self-report depression scale for research in the general population. Appl Psychol Meas, 1977, 1: 385-401.
16.	Gratz KL, Roemer L. Multidimensional assessment of emotion regulation and dysregulation: development, factor structure, and initial validation of the difficulties in emotion regulation scale. Sleep, 2004, 26: 41-54.
17.	Nock MK, Wedig MM, Holmberg EB, et al. The emotion reactivity scale: development, evaluation, and relation to self-injurious thoughts and behaviors. Behav Ther, 2008, 39(2): 107-116.
18.	Mw J. A new method for measuring daytime sleepiness: the Epworth sleepiness scale. Sleep, 1991, 14: 540-545.
19.	Yeghiazarians Y, Jneid H, Tietjens JR, et al. Obstructive sleep apnea and cardiovascular disease: a scientific statement from the American Heart Association. Circulation, 2021, 144(3): e56-e67.
20.	Reutrakul S, Mokhlesi B. Obstructive sleep apnea and diabetes: a state of the art review. Chest, 2017, 152(5): 1070-1086.
21.	Vaessen TJA, Overeem S, Sitskoorn MM. Cognitive complaints in obstructive sleep apnea. Sleep Med Rev, 2015, 19: 51-58.
22.	Appleton SL, Vakulin A, McEvoy RD, et al. Undiagnosed obstructive sleep apnea is independently associated with reductions in quality of life in middle-aged, but not elderly men of a population cohort. Sleep and Breath, 2015, 19(4): 1309-1316.
23.	Gupta MA, Simpson FC. Obstructive sleep apnea and psychiatric disorders: a systematic review. J Clin Sleep Med, 2015, 11(2): 165-175.
24.	McCarron RM, Shapiro B, Rawles J, et al. Depression. J Ann Intern Med, 2021, 174(5): ITC65-ITC80.
25.	Malhi GS, Mann JJ. Depression. J Lancet, 2018, 392(10161): 2299-2312.
26.	Ancoli-Israel S, Dimsdale J E. Effect of continuous positive airway pressure vs placebo continuous positive airway pressure on sleep quality in obstructive sleep apnea. Chest, 1999, 116(6): 1545-1549.
27.	Calik MW. Treatments for obstructive sleep apnea. J Clin Outcomes Manag, 2016, 23(4): 181-192.
28.	Giles TL, Lasserson TJ, Smith B, et al. Continuous positive airways pressure for obstructive sleep apnoea in adults. Cochrane Database Syst Rev, 2006, (1): CD001106.
29.	Povitz M, Bolo CE, Heitman SJ, et al. Effect of treatment of obstructive sleep apnea on depressive symptoms: systematic review and meta-analysis. PLoS medicine, 2014, 11(11): e1001762.
30.	Munoz A, Mayoralas LR, Barbe F, et al. Long-term effects of CPAP on daytime functioning in patients with sleep apnoea syndrome. Eur Respir J, 2000, 15(4): 676-681.
31.	Vanek J, Prasko J, Genzor S, et al. Obstructive sleep apnea, depression and cognitive impairment. Sleep Med, 2020, 72: 50-58.
32.	Schwartz DJ, Kohler WC, Karatinos G. Symptoms of depression in individuals with obstructive sleep apnea may be amenable to treatment with continuous positive airway pressure. Chest, 2005, 128(3): 1304-1309.
33.	Hobzova M, Hubackova L, Vanek J, et al. Cognitive function and depressivity before and after cpap treatment in obstructive sleep apnea patients. Neuro Endocrinol Lett., 2017, 38(3): 145-153.
34.	張麗, 邱平云, 孔曉明, 等. 抑郁癥合并OSA患者臨床癥狀、糖脂水平的變化及超短期CPAP治療的影響. 臨床肺科雜志, 2023, 28(3): 394-398.
35.	鄭綺雯, 楊琳, 于蘭芳, 等. CPAP對阻塞性睡眠呼吸暫停低通氣綜合征患者心理狀況的影響. 齊魯護理雜志, 2012, 18(4): 107-108.
36.	Carneiro-Barrera A, Amaro-Gahete FJ, Sáez-Roca G, et al. Anxiety and depression in patients with obstructive sleep apnoea before and after continuous positive airway pressure: The ADIPOSA study. J Clin Sleep Med, 2019, 8(12): 2099.
37.	陳瑞英, 孫婷, 劉峰輝, 等. 重疊綜合征患者睡眠呼吸紊亂特征及持續氣道正壓通氣對嗜睡、疲勞、焦慮抑郁的影響. 世界復合醫學, 2019, 5(3): 151-155.
38.	Gross JJ, Thompson RA. Emotion regulation: conceptual foundations. In: Handbook of emotion regulation. New York: Guilford Press, 2007.
39.	Bylsma LM, Morris BH, Rottenberg J. A meta-analysis of emotional reactivity in major depressive disorder. Clin Psych Rev, 2008, 28(4): 676-691.
40.	Zheng D, Xu Y, You S, et al. Effects of continuous positive airway pressure on depression and anxiety symptoms in patients with obstructive sleep apnoea: results from the sleep apnoea cardiovascular endpoint randomised trial and meta-analysis. EClinicalMedicine, 2019, 11: 89-96.
41.	Dostálová V, Kole?kárová S, Ku?ka M, et al. Effects of continuous positive airway pressure on neurocognitive and neuropsychiatric function in obstructive sleep apnea. J Sleep Res, 2019, 28(5): e12761.
42.	Zhao YY, Wang R, Gleason KJ, et al. Effect of continuous positive airway pressure treatment on health-related quality of life and sleepiness in high cardiovascular risk individuals with sleep apnea: Best Apnea Interventions for Research (BestAIR) Trial. Sleep, 2017, 40(4): zsx040.

1. Benjafield AV, Ayas NT, Eastwood PR, et al. Estimation of the global prevalence and burden of obstructive sleep apnoea: a literature-based analysis. Lancet Respir Med, 2019, 7(8): 687-698.
2. Guglielmi O, Sanchez AI, Jurado-Gamez B, et al. Obesity and sleep quality: the predictors of depression and anxiety in obstructive sleep apnea syndrome patients. Revista de neurologia, 2011, 52(9): 515-521.
3. Harris M, Glozier N, Ratnavadivel R, et al. Obstructive sleep apnea and depression. Sleep Med rev, 2009, 13(6): 437-444.
4. Ong JC, Gress JL, San Pedro-Salcedo MG, et al. Frequency and predictors of obstructive sleep apnea among individuals with major depressive disorder and insomnia. Psychosom Res, 2009, 67(2): 135-141.
5. Saunam?ki T, Jehkonen M. Depression and anxiety in obstructive sleep apnea syndrome: a review. Acta Neurol Scand, 2007, 116(5): 277-288.
6. Jackson ML, Tolson J, Bartlett D, et al. Clinical depression in untreated obstructive sleep apnea: examining predictors and a meta-analysis of prevalence rates. Sleep Med, 2019, 62: 22-28.
7. Nadeem R, Molnar J, Madbouly, et al. Serum inflammatory markers in obstructive sleep apnea: a meta-analysis. J Clin Sleep Med, 2013, 9: 1003-1012.
8. Bozic J, Borovac JA, Galic T, et al. Adropin and inflammation biomarker levels in male patients with obstructive sleep apnea: a link with glucose metabolism and sleep parameters. J Clin Sleep Med, 2018, 14(7): 1109-1118.
9. Aikens JE, Caruana-Montaldo B, Vanable PA, et al. MMPI correlates of sleep and respiratory disturbance in obstructive sleep apnea. Sleep, 1999, 22(3): 362-369.
10. Reyes-Zuniga M, Castorena -Maldonado A, Carrillo -Alduenda JL, et al. Anxiety and depression symptoms in patients with sleepdisordered breathing. Open Respir Med J, 2012, 6(1): 97-103.
11. 倪明, 岳偉華, 劉破資. 睡眠呼吸暫停低通氣綜合征患者的抑郁焦慮癥狀研究. 中國臨床心理學雜志, 2004, 12(2): 192-193.
12. Bardwell WA, Norman D, Ancoli-Israel S, et al. Effects of 2-week nocturnal oxygen supplementation and continuous positive airway pressure treatment on psychological symptoms in patients with obstructive sleep apnea: a randomized placebo-controlled study. Behav Sleep Med, 2007, 5(1): 21-38.
13. Cross RL, Kumar R, Macey PM, et al. Neural alterations and depressive symptoms in obstructive sleep apnea patients. Sleep, 2008, 31(8): 1103-1109.
14. 中華醫學會, 中華醫學會雜志社, 中華醫學會全科醫學分會, 中華醫學會呼吸病學分會睡眠呼吸障礙學組, 中華醫學會《中華全科醫師雜志》編輯委員會, 呼吸系統疾病基層診療指南編寫專家組. 成人阻塞性睡眠呼吸暫停基層診療指南(2018年). 中華全科醫師雜志, 2019, 18(1): 21-29.
15. Radloff LS. The CES-D scale: a self-report depression scale for research in the general population. Appl Psychol Meas, 1977, 1: 385-401.
16. Gratz KL, Roemer L. Multidimensional assessment of emotion regulation and dysregulation: development, factor structure, and initial validation of the difficulties in emotion regulation scale. Sleep, 2004, 26: 41-54.
17. Nock MK, Wedig MM, Holmberg EB, et al. The emotion reactivity scale: development, evaluation, and relation to self-injurious thoughts and behaviors. Behav Ther, 2008, 39(2): 107-116.
18. Mw J. A new method for measuring daytime sleepiness: the Epworth sleepiness scale. Sleep, 1991, 14: 540-545.
19. Yeghiazarians Y, Jneid H, Tietjens JR, et al. Obstructive sleep apnea and cardiovascular disease: a scientific statement from the American Heart Association. Circulation, 2021, 144(3): e56-e67.
20. Reutrakul S, Mokhlesi B. Obstructive sleep apnea and diabetes: a state of the art review. Chest, 2017, 152(5): 1070-1086.
21. Vaessen TJA, Overeem S, Sitskoorn MM. Cognitive complaints in obstructive sleep apnea. Sleep Med Rev, 2015, 19: 51-58.
22. Appleton SL, Vakulin A, McEvoy RD, et al. Undiagnosed obstructive sleep apnea is independently associated with reductions in quality of life in middle-aged, but not elderly men of a population cohort. Sleep and Breath, 2015, 19(4): 1309-1316.
23. Gupta MA, Simpson FC. Obstructive sleep apnea and psychiatric disorders: a systematic review. J Clin Sleep Med, 2015, 11(2): 165-175.
24. McCarron RM, Shapiro B, Rawles J, et al. Depression. J Ann Intern Med, 2021, 174(5): ITC65-ITC80.
25. Malhi GS, Mann JJ. Depression. J Lancet, 2018, 392(10161): 2299-2312.
26. Ancoli-Israel S, Dimsdale J E. Effect of continuous positive airway pressure vs placebo continuous positive airway pressure on sleep quality in obstructive sleep apnea. Chest, 1999, 116(6): 1545-1549.
27. Calik MW. Treatments for obstructive sleep apnea. J Clin Outcomes Manag, 2016, 23(4): 181-192.
28. Giles TL, Lasserson TJ, Smith B, et al. Continuous positive airways pressure for obstructive sleep apnoea in adults. Cochrane Database Syst Rev, 2006, (1): CD001106.
29. Povitz M, Bolo CE, Heitman SJ, et al. Effect of treatment of obstructive sleep apnea on depressive symptoms: systematic review and meta-analysis. PLoS medicine, 2014, 11(11): e1001762.
30. Munoz A, Mayoralas LR, Barbe F, et al. Long-term effects of CPAP on daytime functioning in patients with sleep apnoea syndrome. Eur Respir J, 2000, 15(4): 676-681.
31. Vanek J, Prasko J, Genzor S, et al. Obstructive sleep apnea, depression and cognitive impairment. Sleep Med, 2020, 72: 50-58.
32. Schwartz DJ, Kohler WC, Karatinos G. Symptoms of depression in individuals with obstructive sleep apnea may be amenable to treatment with continuous positive airway pressure. Chest, 2005, 128(3): 1304-1309.
33. Hobzova M, Hubackova L, Vanek J, et al. Cognitive function and depressivity before and after cpap treatment in obstructive sleep apnea patients. Neuro Endocrinol Lett., 2017, 38(3): 145-153.
34. 張麗, 邱平云, 孔曉明, 等. 抑郁癥合并OSA患者臨床癥狀、糖脂水平的變化及超短期CPAP治療的影響. 臨床肺科雜志, 2023, 28(3): 394-398.
35. 鄭綺雯, 楊琳, 于蘭芳, 等. CPAP對阻塞性睡眠呼吸暫停低通氣綜合征患者心理狀況的影響. 齊魯護理雜志, 2012, 18(4): 107-108.
36. Carneiro-Barrera A, Amaro-Gahete FJ, Sáez-Roca G, et al. Anxiety and depression in patients with obstructive sleep apnoea before and after continuous positive airway pressure: The ADIPOSA study. J Clin Sleep Med, 2019, 8(12): 2099.
37. 陳瑞英, 孫婷, 劉峰輝, 等. 重疊綜合征患者睡眠呼吸紊亂特征及持續氣道正壓通氣對嗜睡、疲勞、焦慮抑郁的影響. 世界復合醫學, 2019, 5(3): 151-155.
38. Gross JJ, Thompson RA. Emotion regulation: conceptual foundations. In: Handbook of emotion regulation. New York: Guilford Press, 2007.
39. Bylsma LM, Morris BH, Rottenberg J. A meta-analysis of emotional reactivity in major depressive disorder. Clin Psych Rev, 2008, 28(4): 676-691.
40. Zheng D, Xu Y, You S, et al. Effects of continuous positive airway pressure on depression and anxiety symptoms in patients with obstructive sleep apnoea: results from the sleep apnoea cardiovascular endpoint randomised trial and meta-analysis. EClinicalMedicine, 2019, 11: 89-96.
41. Dostálová V, Kole?kárová S, Ku?ka M, et al. Effects of continuous positive airway pressure on neurocognitive and neuropsychiatric function in obstructive sleep apnea. J Sleep Res, 2019, 28(5): e12761.
42. Zhao YY, Wang R, Gleason KJ, et al. Effect of continuous positive airway pressure treatment on health-related quality of life and sleepiness in high cardiovascular risk individuals with sleep apnea: Best Apnea Interventions for Research (BestAIR) Trial. Sleep, 2017, 40(4): zsx040.

Chinese Journal of Respiratory and Critical Care Medicine

The impact of CPAP therapy on depressive symptom scores, emotional regulation and reactivity in OSA patients

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