Antidepressants and OSA

[Mikesus]

Simultaneous Use of Antidepressant and Antihypertensive Medications Increases Likelihood of Diagnosis of Obstructive Sleep Apnea Syndrome

Robert J. Farney, MD, FCCP; Alejandra Lugo, BA; Robert L. Jensen, PhD; James M. Walker, PhD and Tom V. Cloward, MD, FCCP

* From the Intermountain Sleep Disorders Center (Drs. Farney, Walker, and Cloward), Medical Informatics (Ms. Lugo), and Pulmonary Division, Department of Medicine (Dr. Jensen), LDS Hospital, Salt Lake City, UT.

Correspondence to: Robert J. Farney, MD, FCCP, Intermountain Sleep Disorders Center, LDS Hospital, 325 Eighth Ave and C St, Salt Lake City, UT 84143; e-mail: rjfmd@msn.com

Background: Essential hypertension and symptoms of depression such as unexplained fatigue and tiredness are frequently encountered in primary medical care clinics. Although, exhaustive evaluation rarely detects unsuspected underlying disorders, obstructive sleep apnea (OSA) is commonly associated with each of these conditions. We tested the hypothesis that therapy with antihypertensive and antidepressant medications predicts the increased likelihood of OSA.

Methods: We analyzed the computer archive of 212,972 patients for prescriptions for antihypertensive medications, antidepressant medications, and International Classification of Diseases, Ninth Revision codes for OSA. Prevalence, prevalence odds ratio (POR), and confidence intervals (CIs) were calculated correcting for gender and age group.

Results: The prevalence rates of OSA were 0.8%, 2.8%, and 3.2% for men and 0.4%, 1.4%, and 1.8% for women aged 20 to 39 years, 40 to 59 years, and >= 60 years, respectively. Compared to groups of corresponding age and gender who had not received prescriptions for either hypertension or depression, the highest PORs were found in patients receiving medications from both categories: 18.30 (95% CI, 10.69 to 25.66), 5.72 (95% CI, 4.10 to 6.70), and 4.47 (95% CI, 2.45 to 7.01) for men, and 17.43 (95% CI, 9.54 to 28.67), 7.29 (95% CI, 5.20 to 9.29), and 2.72 (95% CI, 1.48 to 4.73) for women.

Conclusions: We found that the likelihood of having a diagnosis of OSA increases when either antihypertensive or antidepressant medications have been prescribed. The probability is highest in the young and middle-age groups receiving prescriptions for both medications. The possibility of OSA should be considered in any patient with hypertension and depression or unexplained fatigue who is receiving antihypertensive and antidepressant medications.

[NeurosurgeryNP]

I hear you Mike,

I was there...I was diagnoses with depression a year after 9/11. I lost a friend in the WTC attacks, and I was sad...frankly, the whole nation was sad. But, I was sleeping excessively....have been right through college though. A year after 9/11, I lost another close friend to illness. So, between being sad, and sleeping ALL of the time, and not feeling rested, I was diagnosed with depression.

This all changes when in January, during a visit to my pulmonologist, I revisited my concerns about my sleepiness..especially duing the day. I could sleep 10 hours a night, and still need a 2 hour nap during the day - just about every day. Although the Paxil had helped my sadness, as well as time did, the sleepiness never went away. So, he set me up for a sleep study.

I had my first sleep study in mid January. About 1 week later, I found out I had OSA. I was psyched! I was not nuts after all. Weird to be psyched about this diagnosis, but it was a good diagnosis in the sense that it had a treatment, and it didn't mean any type of surgery. I am only on a pressure of 9 and doing well.

I am here 3 weeks later after starting treatment telling you my story, as I have in the past. I beg you to share your with your family, friends and co-workers. So many are out there thinking they are nuts - as I once did. I know also that I have a happier outlook on things that were to befalll me such as hypertension. I was not your typical OSA stereotype. I am a female, 5'8" and 200 lb. A bit overweight, but not what we would have normally thought an OSA pt to be. We know all know that there is no "typical" pt with OSA. This treatment has truly changed my life. I no longer come home from work at 3 PM, jump into bed for 2 hours, only to wake up and go back to bed at 9 PM. I have only taken around 2 - 3 one hours naps since starting!

I preach my story to anyone that will listen. I know of so many co-wrokers that have been suffering from excessive daytime sleepiness. I tell them to go get a sleep study. It has truly changed the way I live my life in such a short amount of time.

By the Way, I went to my primary care dr. and he is starting to taper me off of the Paxil. So far, so good. So, for me, it seems as if the sleepiness was totally related to the OSA.

Take care all,

Jen

[sharonokc]

Which comes first, the depressions and hypertension or the obstructive sleep apnea?

[ozij]

Good question - which this research can't attempt to answer.
What it does mean is: Many people whose depression and hypertension are so bad that they recieve medication, apparently also have sleep apnea. Therfore, dear doctors (and informed patients):
"The possibility of OSA should be considered in any patient with hypertension and depression or unexplained fatigue who is receiving antihypertensive and antidepressant medications.

It's a "how you should think about diagnosis" kind of thing. Not a description of cause and effect. Which does not make it less important.
(my emphasis).

[Mikesus]

Ozij. Exactly. What they are finding now, is that there are a number of OTHER problems that seem to run with OSA. All that means is that when they find one, they also seem to find the other. No cause and effect, just observation that when patients have one, a bunch of patients have the other.

Gives you a better idea of where the research is. They don't know what exactly causes it, but they do know what tends to group together. OSBD/OSA is still a very young field, I think this year we will see a LOT of very interesting studies/papers.

[SleepySue]

I am glad there is research going on concerning the conncections between various conditions. I too am on anitdeppressants and have been for almost 5 years! While I believe I needed them (they clean the cobwebs out of your mind), I took them in conjunction with therapy and can happily say I have been therapy free for over a year! Anyway, like others have stated I still had the excessive tiredness. I was tested for everything from arthritis to MS. Finally, this past January my doctor realized there was something much greater going on - especially when I mentioned to her that my husband said I was snoring like a sick, dying cow! She sent me on a sleep study and voila, I have sleep apnea! I truly believe that a lot of my health concerns are related to my lack of restful sleep. I too could sleep 10 to 18 hours a day, given the opportunity. I tried all the tips and tricks and nothing worked. I would start a simple exercise routine and within 3 days I would have a cold. I believe that since I was not getting the proper sleep, my immune system was run down and with exercise it would run down even more. It is a vicious cycle, one that I am sure many of you are aware.

I too was psyched about my diagnosis. It all made sense and came together. I am now working with my psychiatrist to start backing off on the meds. While the CPAP has not been the greatest to get used to, every night I seem to have a little improvement. I figure all of this did not happen overnight and it is not going to go away overnight either. I just take it a day at a time - that seems to be working for me. I think there are way more people out there with sleep apnea than any of the statistics report, but I think most people do not want to admit they might have a sleep disorder. Education is key and that is why people like us must discuss it openly and push others to look at SA as a possibility!

P.S. - Yeah to dayling savings time!!! I also have SAD and boy am I glad to reach this miletone of the year!!!!