Effects Of Comorbidities Obstructive Sleep Apnea Hypopnea Syndrome On Objective Sleep,Clinical Symptoms And Cognition In Late Life Depression Patients

Objectives:late life depression(LLD)is one of the most common mental disorders in the elderly.Obstructive sleep apnea hypopnea syndrome(OSAHS)is a kind of sleep-related breathing disorder,which is a common chronic disease.OSAHS has an impact on mood,sleep and cognition,which can lead to the aggravation of depressive symptoms and affect the prognosis.However,most of the studies focus on the comorbidity of OSAHS in non-late life depression patients,and the effect of comorbidity of OSAHS on late life depression patients is not clear.The impact of OSAHS on objective sleep,clinical symptoms and cognition in late life depression patients reminds us to pay attention to OSAHS screening and early intervention,so as to provide reference for clinical work in geriatric psychiatry.Methods:A total of 182 late life depression patients who were treated in the Department of Geriatric Psychology of Anhui Mental Health Center from January 2020 to October2022 were enrolled in this study.General information,body mass index(BMI),neck circumference and waist circumference were collected,Hamilton Depression Scale24-item version(HAMD-24),Hamilton Anxiety Scale(HAMA)and Montreal Cognitive Assessment Scale(Mo CA)were used to evaluate the emotional status and cognitive status of all subjects.The objective sleep status of all subjects was collected by polysomnography(PSG),and the following indicators were observed:(1)sleep process indicators,including total sleep time(TST),sleep efficiency(SE),sleep latency(SL),rapid eye movement sleep latency(RL).(2)Sleep structure indicators: time of non-rapid eye movement sleep stage 1(N1)and proportion(N1%),time of non-rapid eye movement sleep stage 2(N2)and proportion(N2%),time of non-rapid eye movement sleep stage 3(N3)and proportion(N3%),time of rapid eye movement sleep(RT)and proportion(REM%).(3)Sleep respiratory events: apnea hypopnea index(AHI),mean apnea duration(MAD),longest apnea duration(LAD),mean oxygen saturation(MSa O2)and minimum oxygen saturation(LSa O2).According to the presence or absence of sleep apnea,88 late life depression patients who met the diagnostic criteria of OSAHS were included in the comorbidity OSAHS group,94 late life depression patients without OSAHS were included in the late life depression group,and 30 the elderly without OSAHS and depression were included in the normal control group.Finally,the collected data and monitoring results were statistically analyzed by SPSS22.0.Results:1.There were significant differences in BMI(F=15.501,P < 0.001),neck circumference(F=78.754,P < 0.001)and waist circumference(F=31.699,P < 0.001)among the three groups.Further pairwise comparison showed that,the BMI,neck circumference and waist circumference of the comorbidity OSAHS group and the late life depression group were higher than those of the normal control group,and the difference was statistically significant(P < 0.001).The BMI,neck circumference and waist circumference of the group with comorbid OSAHS were greater than those of the late life depression group,and the difference was statistically significant(P < 0.05).2.The incidence of snoring,observed apnea and inattention in the comorbid OSAHS group was higher than that in the late life depression group and the normal control group,and the differences were statistically significant(P < 0.05).3.The incidence of hypertension in the comorbidity OSAHS group and the late life depression group was higher than that in the normal control group,and the incidence of hypertension in the comorbidity OSAHS group was higher than that in the late life depression group,and the incidence of arrhythmia and diabetes in the comorbidity OSAHS group was higher than that in the late life depression group and the normal control group,and the differences were statistically significant(P < 0.05).4.The TST and SE of the comorbidity OSAHS group and the late life depression group were shorter than those of the normal control group,and the TST and SE of the comorbidity OSAHS group were shorter than those of the late life depression group,the SL of the comorbidity OSAHS group and the late life depression group was longer than that of the normal control group,and the RL was shorter than that of the normal control group,and the differences were statistically significant(P < 0.05).Compared with the late life depression group and the normal control group,the comorbid OSAHS group had significantly longer N1 and N1%,significantly longer N2 and N2%,significantly shorter RT and REM%,and significantly longer N2 and N3%,significantly shorter N3 and N3%,and significantly shorter RT and REM%,and significantly longer N2 and N3%,and significantly shorter N3 and N3%,significantly shorter RT and REM%,and significantly longer N2 and N3% in the late life depression group than in the normal control group.In the late life depression group,N2% was longer than that in the normal control group,and N3 and N3% were shorter than that in the normal control group(P <0.05).The AHI,MAD and LAD in the comorbid OSAHS group were higher than those in the late life depression group and the normal control group,and MSa O2 and LSa O2 were lower than those in the late life depression group and the normal control group,and MSa O2 and LSa O2 in the late life depression group were lower than those in the normal control group,and the differences were statistically significant(P < 0.05).5.The total scores of HAMD-24 and HAMA in the comorbidity OSAHS group and the late life depression group were higher than those in the normal control group,and the total scores of Mo CA in the comorbidity OSAHS group were higher than those in the late life depression group,and the total score of Mo CA was lower than that in the late life depression group,and the differences were statistically significant(P < 0.05).6.Correlation analysis shows that,in the comorbidity OSAHS group the total score of HAMD-24 was negatively correlated with TST,SE,N2,N2% and MSa O2,and positively correlated with N1%.The total score of HAMA was negatively correlated with MSa O2 and LSa O2,and the total score of Mo CA was positively correlated with MSa O2 and LSa O2.The total score of Mo CA was positively correlated with MSa O2 and LSa O2,and the differences were statistically significant(P < 0.05).7.MAD is a risk factor and MSa O2 is a protective factor for severe depression in late life depression patients.8.The course of depression and LAD are the risk factors for cognitive impairment in late life depression patients,and years of education,N3% and MSa O2 are the protective factors for cognitive impairment in late life depression patients.Conclusions:The comorbidity of OSAHS affects the clinical manifestations of late life depression patients,increases the risk of physical diseases such as hypertension,arrhythmia and diabetes,affects the sleep process and sleep structure,aggravates sleep disorders,and aggravates emotional and cognitive impairment.The influencing factors of severe depression and cognitive impairment in late life depression patients were analyzed,and found that the longer the duration of apnea and the more severe the hypoxia,the more serious the depressive symptoms and cognitive impairment,the longer the course of depression,the shorter the years of education,the less proportion of slow-wave sleep,the more serious the cognitive impairment.Therefore,in clinical work,early identification and early intervention of OSAHS is beneficial to the treatment of late life depression patients,and may improve the prognosis and quality of life of late life depression patients.