Cited by 147Obstructive Sleep Apnea ResearchSleep and related disordersTemporomandibular Joint Disorders

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Effect of Treatment of Obstructive Sleep Apnea on Depressive Symptoms: Systematic Review and Meta-Analysis

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Povitz, Marcus, Bolo, Carmelle E., Heitman, Steven J., Tsai, Willis H., Wang, JianLi, James, Matthew T.·2014·PLoS Medicine

DOI 10.1371/journal.pmed.1001762PMC PMC4244041

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Abstract

BACKGROUND: Obstructive sleep apnea (OSA) is associated with increased morbidity and mortality, and decreased quality of life. Treatment with continuous positive airway pressure (CPAP) or mandibular advancement devices (MADs) is effective for many symptoms of OSA. However, it remains controversial whether treatment with CPAP or MAD also improves depressive symptoms. METHODS AND FINDINGS: We performed a systematic review and meta-analysis of randomized controlled trials that examined the effect of CPAP or MADs on depressive symptoms in patients with OSA. We searched Medline, EMBASE, the Cochrane Central Registry of Controlled Trials, and PsycINFO from the inception of the databases until August 15, 2014, for relevant articles. In a random effects meta-analysis of 19 identified trials, CPAP treatment resulted in an improvement in depressive symptoms compared to control, but with significant heterogeneity between trials (Q statistic, p<0.001; I(2) = 71.3%, 95% CI: 54%, 82%). CPAP treatment resulted in significantly greater improvement in depressive symptoms in the two trials with a higher burden of depression at baseline (meta-regression, p<0.001). The pooled standardized mean difference (SMD) in depressive symptoms with CPAP treatment in these two trial populations with baseline depression was 2.004 (95% CI: 1.387, 2.621), compared to 0.197 (95% CI: 0.059, 0.334) for 15 trials of populations without depression at baseline. Pooled estimates of the treatment effect of CPAP were greater in parallel arm trials than in crossover trials (meta-regression, p = 0.076). Random effects meta-analysis of five trials of MADs showed a significant improvement in depressive symptoms with MADs versus controls: SMD = 0.214 (95% CI: 0.026, 0.401) without significant heterogeneity (I(2) = 0%, 95% CI: 0%, 79%). Studies were limited by the use of depressive symptom scales that have not been validated specifically in people with OSA. CONCLUSIONS: CPAP and MADs may be useful components of treatment of depressive symptoms in individuals with OSA and depression. The efficacy of CPAP and MADs compared to standard therapies for depression is unknown. Please see later in the article for the Editors' Summary.

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Figure 1 PRISMA flow diagram [12]. All medical databases were searched on the same date. Abstract, full-text review, and data extraction were conducted in duplicate by M. P. and C. E. B. APA, American Psychiatric Association; ATS, American Thoracic Society; APSS, Associated Professional Sleep Societies; CENTRAL, Cochrane Central Registry of Controlled Trials.CC BY · PubMed Central

Figure 2 CPAP studies forest plot. Data were calculated by a random effects model. Studies were stratified by baseline depression score. Boxes are SMDs, and lines are 95% CIs. The vertical solid line represents no difference between CPAP and control. Values to the right of the solid line favor CPAP benefit. Pooled SMDs and 95% CIs are represented by the diamond shapes.CC BY · PubMed Central

Figure 3 MAD studies forest plot. Data were calculated by a random effects model. Boxes are SMDs, and lines are 95% CIs. The vertical solid line represents no difference between MAD and control. Values to the right of the solid line favor MAD benefit. Pooled SMD and 95% CI is represented by the diamond shape.CC BY · PubMed Central

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Authors: Povitz, M., Bolo, C. E., Heitman, S. J., Tsai, W. H., Wang, J., & James, M. T.
Affiliations: Western University (CA)
University of Calgary (CA)
Corresponding author: James, Matthew T.
ORCID: Povitz, Marcus
Heitman, Steven J.
Tsai, Willis H.
Wang, JianLi
James, Matthew T.
Venue: PLoS Medicine
Publisher: Public Library of Science (PLoS)
Published: 2014-11-25
Volume: 11
Issue: 11
Pages: e1001762
ISSN: 1549-1277 (ISSN-L)
1549-1676
DOI: 10.1371/journal.pmed.1001762
PMC: PMC4244041
OpenAlex: W2096306751
Cited by: 147
References: 67
Citations by year: 2026: 8 · 2025: 7 · 2024: 14 · 2023: 10 · 2022: 14 · 2021: 15 · 2020: 13 · 2019: 10 · 2018: 17 · 2017: 12 · 2016: 15 · 2015: 10 · 2014: 1
FWCI: 1.49
Type: journal article
Language: en
Open access: gold
doi.org
Licence: cc-by
creativecommons.org/licenses/by/4.0/ (unspecified)
Locations: PLoS Medicine (publishedVersion, cc-by)
Europe PMC (PubMed Central) (publishedVersion, cc-by)
PubMed Central (publishedVersion, cc-by)
PubMed (publishedVersion)
RePEc: Research Papers in Economics (submittedVersion)
DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
Figshare (submittedVersion, cc-by)
Topics: Health Sciences › Medicine › Physiology (medical) › Obstructive Sleep Apnea Research
Social Sciences › Psychology › Experimental and Cognitive Psychology › Sleep and related disorders
Health Sciences › Dentistry › Oral Surgery › Temporomandibular Joint Disorders
Keywords: obstructive sleep apnea, depressive symptoms, depression, continuous positive airway pressure, mandibular advancement device, sleep apnea treatment, quality of life, quality of life interventions, sleep-disordered breathing, sleep apnea comorbidity
MeSH terms: Depression, Humans, Quality of Life, Mandibular Advancement, Sleep Apnea, Obstructive, Continuous Positive Airway Pressure

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Effect of Treatment of Obstructive Sleep Apnea on Depressive Symptoms: Systematic Review and Meta-Analysis

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