Depressive symptoms after surgical and medical management of OSA: a systematic review and meta-analysis

Purpose: To evaluate the effect of CPAP and surgical alternatives for OSA on depression and compare the results of surgery to CPAP. ​METHODS: COCHRANE Library, CINAHL, PubMed, and Scopus databases were searched for English-language articles. Meta-analysis of continuous measures (mean), proportions (%), and mean difference (Δ) with 95% confidence interval was conducted for objective and subjective outcomes before and after treatment with CPAP or surgical interventions.

Results: We identified 2018 abstracts, 14 studies (N = 3,488) were included in the meta-analysis. Both treatments witnessed significant improvement in Apnea-hypopnea Index (AHI), with similar improvement with CPAP (Δ-48.8 [-51.2, -46.4]) and surgical interventions (Δ -20.22 [-31.3, -9.17]). An improvement in Epworth Sleepiness Scale (ESS) was noted between groups with (Δ -3.9 [-6.2, -1.6]) for the CPAP group and (Δ -4.3 [-6.0, -2.5]) for surgical interventions. The improvement of BDI II depression scores pre- and post-treatment was comparable between treatments with (Δ -4.1 [-5.8, -2.4]) for the CPAP group and (Δ- 5.6 [-9.2, -2.0]) for surgical interventions.

Conclusion: Our findings suggest a reduction in AHI is seen in both CPAP and surgical interventions for OSA, with no difference in AHI reduction between groups. Both treatments also lead to a similar improvement in depression scores providing strong evidence regards impact of surgery on OSA-associated mood disorders. While percent reduction in depression is higher in the surgical group, the difference did not reach statistical significance when compared to CPAP. When stratified by surgical intervention, most interventions suggest an improvement in depression scores.