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Depression and Obstructive Sleep Apnea in Patients With Coronary Heart Disease

From the Departments of Psychiatry (R.M.C., W.B.H., K.E.F.), Neurology (S.P.D.), and Medicine (P.K.S., M.W.R.), Washington University School of Medicine, St. Louis, Missouri; and the Department of Psychology (G.E.M.), University of British Columbia, Vancouver, Canada.

Address correspondence and reprint requests to Robert M. Carney, PhD, Behavioral Medicine Center, 4625 Lindell Blvd., Suite 420, St. Louis, MO 63108. E-mail: carneyr{at}bmc.wustl.edu

Objective: Depression is a risk factor for cardiac events in patients with coronary heart disease (CHD). Obstructive sleep apnea/hypopnea syndrome (OSAHS) is frequently comorbid with depression and is also a risk factor for cardiac events. Undetected OSAHS could help explain the increased risk associated with depression.

Methods: Medically stable patients with CHD and major (MD, n = 53), minor (md, n = 36), or no depression (ND, n = 43) were evaluated for 2 nights in a sleep medicine laboratory.

Results: The prevalence of OSAHS did not differ across groups (MD 66%, md 69%, ND 77%; p > .05). Patients with MD had a significantly greater frequency of apneic episodes, a significantly longer duration of apneas and hyponeas, and more oxygen desaturations per hour than those with md, but there were no differences between MD and ND in frequency of apneic episodes or oxygen desaturations. However, males with MD tended to have more obstructive episodes per hour than did ND males, whereas females with MD had fewer episodes than did ND females. Apnea duration was longer in patients with MD compared with patients with no ND. There was no difference in the mean duration of apnea per hour between the md and ND groups.

Conclusions: Although OSAHS is not more common in depressed patients with CHD, MD is associated with longer obstructive sleep apneic episodes in both men and women and with a higher frequency of episodes in men.

Key Words: depression • sleep-disordered breathing • coronary heart disease

Abbreviations: CHD = coronary heart disease; MD = major depression; md = minor depression; ND = nondepressed; OSAHS = obstructive sleep apnea/hypopnea syndrome; AHI = apnea/hypopnea index; LVEF = left ventricular ejection fraction; BDI = Beck Depression Inventory; BMI = body mass index; DISH = Depression Interview and Structured Hamilton.

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