Does obstructive sleep apnea confound sleep architecture findings in subjects with depressive symptoms?

Background: Compared with normal subjects, depressed patients have shorter rapid eye movement sleep latency (REML), increased REM and decreased slow w ave sleep as a percentage of total sleep time (REM%, SWS%), and longer slee p latency (SL). Obstructive sleep apnea (OSA) patients experience longer RE ML, decreased REM% and SWS%, and shorter SL. We examined the interplay of d epressive symptoms, OSA, and sleep architecture. Methods: Subjects (n = 106) were studied with polysomnography. OSA was defi ned as a Respiratory Disturbance index greater than or equal to 15. Subject s were divided into Hi/Lo groups using Center for Epidemiological Studies-D epression (CES-D) score of 16. Results: OSA patients had shorter SL than non-OSA patients (14.5 vs. 26.8 m in, p < .001); Hi CES-D subjects showed a trend toward longer SL than Lo CE S-D subjects (23.7 vs. 17.5 min, p = .079). Significant OSA X CES-D interac tions emerged however, for REM% (p = .040) and SL (p = .002): OSA/Hi CES-D subjects had higher REM% than OSA/Lo CES-D subjects (19.3% vs. 14.3%, p = . 021); non-OSA/Hi CES-D subjects had SL (35.3 min) 2-3 times as long as othe r subjects (p = .002-.012). Conclusions: Because of the high prevalence of OSA and depression, findings suggest that OSA must be considered in studies of mood and sleep architect ure. Conversely, depressive symptoms must be considered in studies of OSA a nd sleep architecture. (C) 2000 Society of Biological Psychiatry.