Abstract
Background : Studies have suggested that both depression and sleep disordered breathing (SDB) are strongly associated with circulatory disease. However, the relationship between SDB and sleep or depressive symptoms is still uncertain. Methods : Cross-sectional, analytical and exploratory study. The sample consisted of 628 patients. Data were collected from consecutive adult patients referred to the Department of Cardio-Vascular Medicine, Kurume University School of Medicine Unit from May 2010 to October 2012. All patients routinely completed a comprehensive questionnaires that included question about QOL (EQ-5D), sleep habits (PSQI), subjective sleepiness (Epworth Sleepiness Scale), and depression (Patient Health Questionnaire-9). All patients were screened for SDB using pulse oximeter and were performed echocardiography. Furthermore, of the 628 patients, 250 were performed full polysomnography. Results : Depression was present in only 5.7% of patients. But the degree of the depression symptoms had associations with insomnia, QOL, sleepiness and the right ventricle afterload. SDB (AHI≧5) was present in 83.5% of patients (10.6% central [CSA], 72.9% obstructive sleep apnea [OSA]). 3%ODI (or AHI) was not correlated with PHQ-9, PSQI, ESS, QOL ; left atrial diameter (LAD) and the early mitral annular velocity (E/e) were correlated with SDB severity (p<0.001). On the other hand, most of patients (91.2%) with both heart failure and SDB did not complain of sleepiness. Of the 138 patients who meet the clinical criteria for CPAP therapy, 83 patients refused to use CPAP and the rest of 55 patients (39.9%) were prescribed CPAP The SAS patients refused to use CPAP showed significantly lower scores in ESS, PHQ-9 and obstructive apnea index than patients using CPAP. Conclusion : This study demonstrates that SDB induces a functional burden on the left atrium, while depression symptoms had association with right ventricle afterload. In the patients with heart failure, the absence of subjective sleepiness may decrease the rate of utilization of CPAP.
