Although sleep apnea experts routinely try to enhance and create newer, more comfortable PAP equipment (including things like CPAP and AutoPAP), it remains difficult to predict who will use the treatment and who will not. However, there are many who specifically research this topic with hopes that pinpointing the poorer users will allow for targeted intervention, improving overall use in these subjects. Faulty machinery (leakiness and poorly fitting masks to name just a couple), disease severity, and race have all shown to be predictors of poor CPAP use. But what about mental health issues?
Recently, a group of researchers tried to answer this question. They set out to examine whether or not mental health issues detected before PAP initiation could be predictors of poor treatment use. This question was tested using the AutoPAP (a CPAP-like device that automatically adjusts pressures throughout the night) use data. This data was obtained using the recording system within the machine itself. AutoPAP was used in the home for about 7 nights to find the most efficient pressure for each subject. The research team then looked at health records obtained prior to using the AutoPAP and sought a relationship between the mental health records (namely depression and anxiety) and treatment usage.
When comparing the poor users with the consistent users, results showed that depression was a significant predictor for fewer hours of AutoPAP use. Important to note was that obesity was also related to a higher amount of depression. Also involved in this association was the amount of residual apneas and hypopneas present after initiation of the treatment. This should not be surprising, given that these patients were probably less likely to use their machine if they were still having respiratory events1.
This study suggests that higher levels of depression may be a predisposition for poor sleep apnea treatment use. Interestingly, high anxiety, which is the more intuitive candidate for causing avoidance of treatment, was not related to poor use. Overall, the findings from this study are unfortunate, given that properly treated sleep apnea may help alleviate mental health issues, including depression.
Pre-publication: Journal of Clinical Sleep Medicine: Depression may reduce adherence during CPAP titration trial