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Kan Parametreleri ile Uyku, Anksiyete ve Depresyon Belirtileri Arasındaki İlişki: Retrospektif Polisomnografi Çalışması

Year 2023, Volume: 33 Issue: 5, 541 - 547, 25.10.2023

Fettah Eren , Faysal Duksal

https://doi.org/10.54005/geneltip.1308110

Abstract

Amaç: Anksiyete ve depresyonun uyku bozukluklaru ve birçok sistemik hastalık ile ilişkili olduğu bilinmektedir. Bu çalışmada polisomnografik kayıtlaması yapılan hastalarda anksiyete ve depresyonun uyku sırasındaki hipoksi, inflamasyon ve tiroid fonksiyonları ile ilişkisinin incelenmesi amaçlanmıştır.
Gereç ve Yöntem: Retrospektif kesitsel, hastane tabanlı çalışmaya polisomnografi kaydı yapılan 808 hasta dahil edildi. Vücut kitle indeksi (VKI) hesaplandı. Anksiyete ve depresyon Beck anksiyete ve Beck depresyon envanteri ile değerlendirildi. Hastalar anksiyete ve depresyon skorlarına göre gruplara ayrıldı. Polisomnografi kayıtlarından apne hipopne indeksi (AHI), oksijen desaturasyonu indeksi (ODI), ve periferik oksijen saturasyonu (SaO2) elde edildi.
Bulgular: Çalışmada yaş ortalaması 47,64 ± 12,25 (18-82) yıl olan 528 (%65,3) erkek ve 280 (%34,7) kadın hasta vardı. Üç yüz yedi (%38,0) hastada depresyon saptandı. Hastaların 516 (%63,9) sında hafif, 215 (%26,6) inde orta ve 77 (%9,5)sinde ciddi derecede anksiyete vardı. Depresyon ve anksiyete şiddeti grupları ile tüm polisomnografi parametreleri arasında fark vardı (p=0.001). Depresyon hastalarında serbest-T3 daha düşük, C-reaktif protein (CRP) daha yüksekti (p=0.001, p=0.014). Depresyon şiddetine göre TSH ve FT4 seviyesi farkı belirlendi (p=0.037, p=0.047). Şiddetli anksiyetede CRP yüksek, orta ve şiddetli anksiyetede serbest-T3 daha düşüktü (p=0.008, p=0.003, p=0.001). Lojistik regresyon analizinde serbest-T3, minimum SaO2 ve VKI değerlerinin anksiyete (p=0.002, p=0.033, p=0.031) ve depresyon (p=0.001, p=0.017, p=0.035) üzerinde etkisi vardı.
Sonuç: Anksiyete ve depresyon uyku karakteri başta olmak üzere birçok faktörden etkilenmektedir. Özellikle minimum SaO2, CRP ve serbest-T3 bunların başında gelmektedir.

Keywords

Anksiyete depresyon uyku inflamasyon tiroid fonksiyonu

References

  • Kessler RC, Chiu WT, Demler O, Merikangas KR, Walters EE. Prevalence, severity, and comorbidity of 12-month DSM-IV disorders in the National Comorbidity Survey Replication. Arch Gen Psychiatry. 2005;62:617-27.
  • van Wyk M, McCreesh-Toselli S, Williams S, O Ebrahim I. The distinct roles of OSA and depression severity in day- and night-time symptomatology in OSA patients: a pilot study. Sleep Breath. 2020;24:931-9.
  • Bjorvatn B, Rajakulendren N, Lehmann S, Pallesen S. Increased severity of obstructive sleep apnea is associated with less anxiety and depression. J Sleep Res. 2018;27:e12647.
  • Lee SA, Yoon H, Kim HW. Is severe obstructive sleep apnea associated with less depressive symptoms? J Psychosom Res. 2019;122:6-12.
  • Povitz M, Bolo CE, Heitman SJ, Tsai WH, Wang J, James MT. Effect of treatment of obstructive sleep apnea on depressive symptoms: systematic review and meta-analysis. PLoS Med. 2014;11:e1001762.
  • Parmentier T, Sienaert P. The use of triiodothyronine (T3) in the treatment of bipolar depression: A review of the literature. J Affect Disord. 2018;229:410-4.
  • Fischer S, Ehlert U. Hypothalamic-pituitary-thyroid (HPT) axis functioning in anxiety disorders. A systematic review. Depress Anxiety. 2018;35:98-110.
  • Almeida OP, Alfonso H, Flicker L, Hankey G, Chubb SA, Yeap BB. Thyroid hormones and depression: the Health in Men study. Am J Geriatr Psychiatry. 2011;19:763-70.
  • Dwyer JB, Aftab A, Radhakrishnan R, Widge A, Rodriguez CI, Carpenter LL, et al. Hormonal Treatments for Major Depressive Disorder: State of the Art. Am J Psychiatry. 2020;177:686-705.
  • Williams MD, Harris R, Dayan CM, Evans J, Gallacher J, Ben-Shlomo Y. Thyroid function and the natural history of depression: findings from the Caerphilly Prospective Study (CaPS) and a meta-analysis. Clin Endocrinol (Oxf). 2009;70:484-92.
  • Köhler-Forsberg O, Buttenschøn HN, Tansey KE, Maier W, Hauser J, Dernovsek MZ, et al. Association between C-reactive protein (CRP) with depression symptom severity and specific depressive symptoms in major depression. Brain Behav Immun. 2017; 62:344-50.
  • Ittermann T, Völzke H, Baumeister SE, Appel K, Grabe HJ. Diagnosed thyroid disorders are associated with depression and anxiety. Soc Psychiatry Psychiatr Epidemiol. 2015;50:1417-25.
  • Tayefi M, Shafiee M, Kazemi-Bajestani SMR, Esmaeili H, Darroudi S, Khakpouri S, et al. Depression and anxiety both associate with serum level of hs-CRP: A gender-stratified analysis in a population-based study. Psychoneuroendocrinol. 2017;81:63-9.
  • Duivis HE, Vogelzangs N, Kupper N, de Jonge P, Penninx BW. Differential association of somatic and cognitive symptoms of depression and anxiety with inflammation: findings from the Netherlands Study of Depression and Anxiety (NESDA). Psychoneuroendocrinol. 2013;38:1573-85.
  • Vogelzangs N, Beekman AT, de Jonge P, Penninx BW. Anxiety disorders and inflammation in a large adult cohort. Transl Psychiatry. 2013;3:e249.
  • Beck AT, Steer RA, Garbin MG. Psychometric properties of the Beck Depression Inventory: Twenty-five years of evaluation. Clin Psychol Rev. 1988;8:77-100.
  • Beck AT, Epstein N, Brown G, Steer RA. An inventory for measuring clinical anxiety: psychometric properties. J Consult Clin Psychol. 1988;56:893-7.
  • Kapur VK, Auckley DH, Chowdhuri S, Kuhlmann DC, Mehra R, Ramar K, et al. Clinical Practice Guideline for Diagnostic Testing for Adult Obstructive Sleep Apnea: An American Academy of Sleep Medicine Clinical Practice Guideline. J Clin Sleep Med. 2017;13:479-504.
  • Akberzie W, Hesselbacher S, Aiyer I, Surani S, Surani ZS. The Prevalence of Anxiety and Depression Symptoms in Obstructive Sleep Apnea. Cureus 2020;12:e11203.
  • Edwards C, Mukherjee S, Simpson L, Palmer LJ, Almeida OP, Hillman DR. Depressive Symptoms before and after Treatment of Obstructive Sleep Apnea in Men and Women. J Clin Sleep Med. 2015;11:1029-38.
  • Sforza E, Saint Martin M, Barthélémy JC, Roche F. Mood disorders in healthy elderly with obstructive sleep apnea: a gender effect. Sleep Med. 2016;19:57-62.
  • Björnsdóttir E, Benediktsdóttir B, Pack AI, Arnardottir ES, Kuna ST, Gíslason T, et al. The Prevalence of Depression among Untreated Obstructive Sleep Apnea Patients Using a Standardized Psychiatric Interview. J Clin Sleep Med. 2016;12:105-12.
  • Atlantis E, Fahey P, Cochrane B, Smith S. Bidirectional associations between clinically relevant depression or anxiety and COPD: a systematic review and meta-analysis. Chest. 2013;144:766-77.
  • Currow DC, Chang S, Reddel HK, Kochovska S, Ferreira D, Kinchin I, et al. Breathlessness, Anxiety, Depression, and Function-The BAD-F Study: A Cross-Sectional and Population Prevalence Study in Adults. J Pain Symptom Manage. 2020;59(2):197-205.
  • Schmaling KB, McKnight PE, Afari N. A prospective study of the relationship of mood and stress to pulmonary function among patients with asthma. J Asthma. 2002;39:501-10.
  • Scano G, Gigliotti F, Stendardi L, Gagliardi E. Dyspnea and emotional states in health and disease. Respir Med. 2013;107:649-55.
  • Vogelzangs N, Duivis HE, Beekman AT, Kluft C, Neuteboom J, Hoogendijk W, et al. Association of depressive disorders, depression characteristics and antidepressant medication with inflammation. Transl Psychiatry. 2012;2:e79.
  • Liukkonen T, Räsänen P, Jokelainen J, Leinonen M, Järvelin MR, Meyer-Rochow VB, et al. The association between anxiety and C-reactive protein (CRP) levels: results from the Northern Finland 1966 birth cohort study. Eur Psychiatry. 2011;26:363-9.
  • Fountoulakis KN, Kantartzis S, Siamouli M, Panagiotidis P, Kaprinis S, Iacovides A, et al.. Peripheral thyroid dysfunction in depression. World J Biol Psychiatry. 2006;7:131-7.
  • Bauer M, Goetz T, Glenn T, Whybrow PC. The thyroid-brain interaction in thyroid disorders and mood disorders. J Neuroendocrinol. 2008;20:1101-14.
  • Cleare A, Pariante CM, Young AH, Anderson IM, Christmas D, Cowen PJ, et al. Evidence-based guidelines for treating depressive disorders with antidepressants: A revision of the 2008 British Association for Psychopharmacology guidelines. J Psychopharmacol. 2015;29:459-525.
  • Larisch R, Kley K, Nikolaus S, Sitte W, Franz M, Hautzel H, et al. Depression and anxiety in different thyroid function states. Horm Metab Res. 2004;36:650-3.
  • Pápai A, Coșa LE, Cozma MM, Mihai A. The role of coping strategies, depression and anxiety in thyroid disease. Orv Hetil. 2021;162:262-8.
  • Lee IT, Sheu WH, Liau YJ, Lin SY, Lee WJ, Lin CC. Relationship of stressful life events, anxiety and depression to hyperthyroidism in an asian population. Horm Res. 2003;60:247-51.

The Relationship Between Blood Parameters, Sleep, Anxiety and Depression Symptoms: A Retrospective Polysomnography Study

Year 2023, Volume: 33 Issue: 5, 541 - 547, 25.10.2023

Fettah Eren , Faysal Duksal

https://doi.org/10.54005/geneltip.1308110

Abstract

Objective: It is known that anxiety and depression are associated with sleep disorders and many systemic diseases. This study aims to analyse the relationship between anxiety, depression symptoms and sleep parameters among the patients subjected to polysomnographic recording.
Material and Methods: A total of 808 patients who were subjected to a polysomnographic recording were included in the retrospective cross-sectional and hospital-based study. Body mass index (BMI) was calculated. Anxiety and depression symptoms were evaluated using the Beck anxiety and Beck depression inventory. Patients were divided into groups according to anxiety and depression scores. The apnoea hypopnea index (AHI), oxygen desaturation index (ODI), and peripheral oxygen saturation (SaO2) were obtained from the polysomnographic recordings.
Results: In the study, there were 528 (65.3%) male and 280 (34.7%) female patients with the mean age 47.64 ± 12.25 (18-82). Depression was detected in 307 (38.0%) patients according to Beck depression score. Mild anxiety symptoms were detected in 516 (63.9%), moderate anxiety symptoms in 215 (26.6%) patients and severe anxiety symptoms in 77 (9.5%) patients according to Beck anxiety score. There was a statistical difference for all polysomnographic parameters in depression and anxiety severity groups (p=0.001). In patients with depression had lower free-T3 and higher C-reactive protein (CRP) levels (p=0.001, p=0.014). The difference between thyroid stimulating hormone (TSH) and FT4 levels was determined according to the severity of the depression (p=0.037, p=0.047). CRP was higher in patients with severe anxiety (p=0.008); and free-T3 was lower in patients with moderate and severe anxiety (p=0.003, p=0.001). In the logistic regression analysis, free-T3, minimum SaO2 and BMI had an impact on anxiety (p=0.002, p=0.033, p=0.031) and depression (p=0.001, p=0.017, p=0.035).
Conclusion: Anxiety and depression symptoms are affected by numerous factors, especially sleep characteristics. Minimum SaO2, CRP and free-T3 are main predisposing factors on anxiety and depression

Keywords

Anxiety depression sleep inflammation thyroid function

References

  • Kessler RC, Chiu WT, Demler O, Merikangas KR, Walters EE. Prevalence, severity, and comorbidity of 12-month DSM-IV disorders in the National Comorbidity Survey Replication. Arch Gen Psychiatry. 2005;62:617-27.
  • van Wyk M, McCreesh-Toselli S, Williams S, O Ebrahim I. The distinct roles of OSA and depression severity in day- and night-time symptomatology in OSA patients: a pilot study. Sleep Breath. 2020;24:931-9.
  • Bjorvatn B, Rajakulendren N, Lehmann S, Pallesen S. Increased severity of obstructive sleep apnea is associated with less anxiety and depression. J Sleep Res. 2018;27:e12647.
  • Lee SA, Yoon H, Kim HW. Is severe obstructive sleep apnea associated with less depressive symptoms? J Psychosom Res. 2019;122:6-12.
  • Povitz M, Bolo CE, Heitman SJ, Tsai WH, Wang J, James MT. Effect of treatment of obstructive sleep apnea on depressive symptoms: systematic review and meta-analysis. PLoS Med. 2014;11:e1001762.
  • Parmentier T, Sienaert P. The use of triiodothyronine (T3) in the treatment of bipolar depression: A review of the literature. J Affect Disord. 2018;229:410-4.
  • Fischer S, Ehlert U. Hypothalamic-pituitary-thyroid (HPT) axis functioning in anxiety disorders. A systematic review. Depress Anxiety. 2018;35:98-110.
  • Almeida OP, Alfonso H, Flicker L, Hankey G, Chubb SA, Yeap BB. Thyroid hormones and depression: the Health in Men study. Am J Geriatr Psychiatry. 2011;19:763-70.
  • Dwyer JB, Aftab A, Radhakrishnan R, Widge A, Rodriguez CI, Carpenter LL, et al. Hormonal Treatments for Major Depressive Disorder: State of the Art. Am J Psychiatry. 2020;177:686-705.
  • Williams MD, Harris R, Dayan CM, Evans J, Gallacher J, Ben-Shlomo Y. Thyroid function and the natural history of depression: findings from the Caerphilly Prospective Study (CaPS) and a meta-analysis. Clin Endocrinol (Oxf). 2009;70:484-92.
  • Köhler-Forsberg O, Buttenschøn HN, Tansey KE, Maier W, Hauser J, Dernovsek MZ, et al. Association between C-reactive protein (CRP) with depression symptom severity and specific depressive symptoms in major depression. Brain Behav Immun. 2017; 62:344-50.
  • Ittermann T, Völzke H, Baumeister SE, Appel K, Grabe HJ. Diagnosed thyroid disorders are associated with depression and anxiety. Soc Psychiatry Psychiatr Epidemiol. 2015;50:1417-25.
  • Tayefi M, Shafiee M, Kazemi-Bajestani SMR, Esmaeili H, Darroudi S, Khakpouri S, et al. Depression and anxiety both associate with serum level of hs-CRP: A gender-stratified analysis in a population-based study. Psychoneuroendocrinol. 2017;81:63-9.
  • Duivis HE, Vogelzangs N, Kupper N, de Jonge P, Penninx BW. Differential association of somatic and cognitive symptoms of depression and anxiety with inflammation: findings from the Netherlands Study of Depression and Anxiety (NESDA). Psychoneuroendocrinol. 2013;38:1573-85.
  • Vogelzangs N, Beekman AT, de Jonge P, Penninx BW. Anxiety disorders and inflammation in a large adult cohort. Transl Psychiatry. 2013;3:e249.
  • Beck AT, Steer RA, Garbin MG. Psychometric properties of the Beck Depression Inventory: Twenty-five years of evaluation. Clin Psychol Rev. 1988;8:77-100.
  • Beck AT, Epstein N, Brown G, Steer RA. An inventory for measuring clinical anxiety: psychometric properties. J Consult Clin Psychol. 1988;56:893-7.
  • Kapur VK, Auckley DH, Chowdhuri S, Kuhlmann DC, Mehra R, Ramar K, et al. Clinical Practice Guideline for Diagnostic Testing for Adult Obstructive Sleep Apnea: An American Academy of Sleep Medicine Clinical Practice Guideline. J Clin Sleep Med. 2017;13:479-504.
  • Akberzie W, Hesselbacher S, Aiyer I, Surani S, Surani ZS. The Prevalence of Anxiety and Depression Symptoms in Obstructive Sleep Apnea. Cureus 2020;12:e11203.
  • Edwards C, Mukherjee S, Simpson L, Palmer LJ, Almeida OP, Hillman DR. Depressive Symptoms before and after Treatment of Obstructive Sleep Apnea in Men and Women. J Clin Sleep Med. 2015;11:1029-38.
  • Sforza E, Saint Martin M, Barthélémy JC, Roche F. Mood disorders in healthy elderly with obstructive sleep apnea: a gender effect. Sleep Med. 2016;19:57-62.
  • Björnsdóttir E, Benediktsdóttir B, Pack AI, Arnardottir ES, Kuna ST, Gíslason T, et al. The Prevalence of Depression among Untreated Obstructive Sleep Apnea Patients Using a Standardized Psychiatric Interview. J Clin Sleep Med. 2016;12:105-12.
  • Atlantis E, Fahey P, Cochrane B, Smith S. Bidirectional associations between clinically relevant depression or anxiety and COPD: a systematic review and meta-analysis. Chest. 2013;144:766-77.
  • Currow DC, Chang S, Reddel HK, Kochovska S, Ferreira D, Kinchin I, et al. Breathlessness, Anxiety, Depression, and Function-The BAD-F Study: A Cross-Sectional and Population Prevalence Study in Adults. J Pain Symptom Manage. 2020;59(2):197-205.
  • Schmaling KB, McKnight PE, Afari N. A prospective study of the relationship of mood and stress to pulmonary function among patients with asthma. J Asthma. 2002;39:501-10.
  • Scano G, Gigliotti F, Stendardi L, Gagliardi E. Dyspnea and emotional states in health and disease. Respir Med. 2013;107:649-55.
  • Vogelzangs N, Duivis HE, Beekman AT, Kluft C, Neuteboom J, Hoogendijk W, et al. Association of depressive disorders, depression characteristics and antidepressant medication with inflammation. Transl Psychiatry. 2012;2:e79.
  • Liukkonen T, Räsänen P, Jokelainen J, Leinonen M, Järvelin MR, Meyer-Rochow VB, et al. The association between anxiety and C-reactive protein (CRP) levels: results from the Northern Finland 1966 birth cohort study. Eur Psychiatry. 2011;26:363-9.
  • Fountoulakis KN, Kantartzis S, Siamouli M, Panagiotidis P, Kaprinis S, Iacovides A, et al.. Peripheral thyroid dysfunction in depression. World J Biol Psychiatry. 2006;7:131-7.
  • Bauer M, Goetz T, Glenn T, Whybrow PC. The thyroid-brain interaction in thyroid disorders and mood disorders. J Neuroendocrinol. 2008;20:1101-14.
  • Cleare A, Pariante CM, Young AH, Anderson IM, Christmas D, Cowen PJ, et al. Evidence-based guidelines for treating depressive disorders with antidepressants: A revision of the 2008 British Association for Psychopharmacology guidelines. J Psychopharmacol. 2015;29:459-525.
  • Larisch R, Kley K, Nikolaus S, Sitte W, Franz M, Hautzel H, et al. Depression and anxiety in different thyroid function states. Horm Metab Res. 2004;36:650-3.
  • Pápai A, Coșa LE, Cozma MM, Mihai A. The role of coping strategies, depression and anxiety in thyroid disease. Orv Hetil. 2021;162:262-8.
  • Lee IT, Sheu WH, Liau YJ, Lin SY, Lee WJ, Lin CC. Relationship of stressful life events, anxiety and depression to hyperthyroidism in an asian population. Horm Res. 2003;60:247-51.
There are 34 citations in total.

Details

Primary Language English
Subjects Clinical Sciences
Journal Section Original Article
Authors

Fettah Eren 0000-0001-6834-0827

Faysal Duksal 0000-0001-7433-5354

Early Pub Date October 23, 2023
Publication Date October 25, 2023
Submission Date May 31, 2023
Published in Issue Year 2023 Volume: 33 Issue: 5

Cite

Vancouver Eren F, Duksal F. The Relationship Between Blood Parameters, Sleep, Anxiety and Depression Symptoms: A Retrospective Polysomnography Study. Genel Tıp Derg. 2023;33(5):541-7.

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