Background: Previous studies have hinted an association between Sleep Apnea Syndrome (SAS) and several psychiatric disorders so as depression and anxiety.

Study objective: To evaluate the association of SAS with psychiatric symptoms as determined from the SCL-90 psychiatric questionnaire.

Methods: The cogitation comprised 2,271 patients (1,977 men 294 women) referr to the Technion drowse Laboratories with suspected SAS. They complet the SCL-90 Symptom Self-Report Inventory and then underwent a whole-night polysomnographic examination. The thought population was stratified into subgroup according to inflection for sex age, and respiratory disturbance index (RDI).

Results: Among men there were no material substance mass index, RDI, or age-related differences in anxiety, depression, or in any other SCL-90 dimension. The depression and anxiety scores were significantly higher in women than in men for all age disposes and for all levels of RDI. The depression score was higher in women with hard SAS than in women with mild SAS, for all ages. Surprisingly, in women who were simply simple snorers, the depression and anxiety scores were higher than in mild SAS sufferer for all age groups

Conclusions: In our large male population, neither the existence nor the severity of SAS was associated with depression or anxiety. Women had higher anxiety and depression scores, independent of other factors, than men Women with sharp SAS had higher depression scores than women with mild SAS. (CHEST 1998; 114:697-703)

Key words: anxiety; depression; gender; psychiatric disorders; SCL-90; slumber apnea

Abbreviations: B MI = material part Mass Index; MMPI = Minnesota Multiphase Personality Inventory; nCPAP=nasal continuous positive airway pressure; OSA=obstruetive lie in the grave apnea; POMS=Profile of Mood States; RDI=Respiratory Disturbance Index; SAS=sleep apnea syndrome; SDS=Self Rating Depression Scale

rest apnea syndrome (SAS) is a universal sleep disorder, prevalent in approximately 3 to 4% of adult men[12] Its frequent occurrence increases with age and with increased material substance mass index (BMI), and it is about couple to nine times more prevalent in men than women[2-4]

Although patients with SAS undergo from fragmented sleep and decreased arterial oxygen saturations, it is still unclear whether SAS is a cause of mental changes and psychiatric abnormalities in a of these patients. Previous reports have linked SAS with depression,[5-11] anxiety,[6,10,11] and cognitive deficits.[6,10,12-14] There have also been reports of a connection between SAS and nocturnal panic attacks[15] and psychoticism.[16] The permanency of these impairments is uncertain. about investigators believe that the impairments can be revers following appropriate treatment[7-10,17]; others, however, have rest some cognitive impairment to persist flat after treatment, most probably appropriate to irreversible anoxic CNS damage.[18] However, the association between SAS and depression could not be confirmed in other studies.[19,20] Furthermore, it has been argued that the association between SAS and psychiatric impairment may eventuate from a misinterpretation by medical staff.[21]

In view of the uncertainty in the literature, we re-evaluated the association between SAS and psychiatric symptoms in a large population of patients. This enabled us to examine the parts of gender, age, and severity of the syndrome in this possible linkage.

MATERIALS AND METHODS

The inquiry population consisted of 2,271 patients (1977 men 294 women) referr from 1992 in consequence of 1995 to tile Technion be dead Laboratories (in Tel Aviv, Jerusalem, and Haifa) with suspected SAS. Each patient complet sum of two units questionnaires and subsequently underwent a whole-night polysomnographic examination. In the first questionnaire, patients answered general questions concerning anthropometric data (such as age and weight) and health information and habits (such as smoking, alcohol consumption, and underlying disease) and specific questions about symptoms and signs characteristic of SAS and other doze disorders (such as snoring, cessation of breathing during be still and daytime somnolence).

The inferior questionnaire was the SCL-90, which is a well-established serf-report clinical rating scale[23-25] that assesses symptomatic behavior of psychiatric outpatients.[22] It comprises the following nine primary symptom scales: somatization, obsession-compulsion, interpersonal sensitivity, depression, anxiety, hostility, phobic anxiety, paranoid ideation, and psychoticism.

After completing the questionnaires, the patients were clinically interviewed by way of a general physician and underwent whole-night polysomnographic evaluation. Surface electrode were used to record EEG electro-oculogram, submental electromyogram, and ECG in a standard fashion.[26] material part movements were also monitored. The vicinity of airflow wits monitored using thermistors positioned at the nose and entrance Efforts at ventilating were monitored using a respiration belt. be dead records were analyzed fin rest stages and occurrence of apneas using standard criteria.[26] Apnea was defined as the cessation of airflow for at least 10 s Hypopnea was defined as a decrease in airflow of at least 50% with a concomitant fall of at least 4% in arterial oxygen saturation followed according to an arousal response (as indicated by way of alpha waves on EEG, increased submental electromyogram flushs and/or increased body movements). The Respiratory Disturbance Index (RDI) was calculated according to dividing the total number of apneic/hypopneic episodes by means of tire hours of sleep. Oxygen saturation horizontals were monitored using pulse oximetry.

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