alcatel-3he04117aa_1

Table 1: Comparison of Apnea vs. Nonapnea Groups Table 2: Comparison of Depressed vs. Nondepressed Groups Apneics Nonapneics p value Age (yrs) 52.8 48.8 NS BMI 35.9 40.2 NS BDI score 7.4 12.2 0.03 Arousal index 58.9 21.5 <0.001 Sex (M/F) 18/2 19/3 NS Legend: yrs = years, BMI = body mass index, BDI = Beck Depression Inventory, M = males, F = females,NS = not significant. Nondepressed Depressed p value Age (yrs) 51.5 48.5 NS BMI 32.2 42.5 NS RDI 31.0 20.5 NS Arousal index 43.8 32.5 NS Sex (M/F) 30/1 7/4 NS Legend: yrs = years, BMI = body massindex, RDI = respiratory distress index, M = males, F = females,NS = not significant. index (BMI), BDI scores and arousal indices were compared between these two groups. We also subdivided this group into two groups based on the BDI score (using 13 or greater as depressed and below 13 as not depressed). The age, sex, BMI, RDI and arousal indices were compared between the two groups. Statistical analysis was done between groups using student's t-test when the sets being compared were normal and Mann-Whitney U test when the sets were skewed. Results We identified a total of 63 patients, 51 men and 12 women, who had filled out the BDI. Of these 18 (29%), 11 men and 7 women, were categorized as depressed. Among the men, 11/51 (22%) were depressed, whereas 7/12 (58%) women were depressed. Of these 63 patients, SA was suspected and PSG results were available for 42. The 21 patients that were excluded were either not suspected to have SA or did not follow-up for a PSG. Analysis of BDI scores of these 21 patients revea- led that 16 (76%) were not depressed and 5 (24%) were depressed; these results were not significantly different from the remainder 42 patients. The remainder of the analysis was done using the 42 patients for whom BDI and PSG data were available. The first set of analyses consisted of dividing these 42 patients into two groups based on whether they had a significant RDI. The apneic group (RDI>15) consisted of 20 (48%) patients and the nonapneic group (RDI<I 5) of 22 (52%) patients. Comparison between the two groups is presented in Table 1. Age, sex and BMI were not significantly different between the two groups. However the BDI scores were significantly higher (p=.03) in the nonapneic group (12.2 vs. 7.4). The arousal index was also significantly higher (p<.001) in the apneic group (58.9/hour vs. 21.5/hour). These 42 patients were also divided into two groups based on whether they were depressed. The nondepressed group (BDI<13) consisted of 31 (74%) patients and the depressed group of 11 (26%) patients. Comparison between the two groups is presented in Table 2. Age, sex, BMI, RDI and arousal indices were not significantly different between the two groups. Discussion Patients are most often referred to sleep dis- orders clinics for evaluation of SA. Symptoms that trigger these referrals are usually daytime fatigue or lethargy, loss of a sense of well being, decreased concentration, depressed libido and snoring coupled with increased weight. Most of these symptoms, however, can also be seen with depression. Thus it becomes important to con- sider depression while evaluating patients for SA. We choose the BDI as a tool for measuring depression as it is simple to administer, has been validated to be a good estimator of depression, and is routinely administered in our clinics. [Johnson, Heather 1974; Rounsaville et al. 1979] A BDI score of 13 or higher has been demon- strated to correlate well with depression. In our patient population we found the inci- dence of depression to be 29%, considerably higher than reported in literature for general medical clinics.[Keaton, Schulberg 1992] There is controversy about the numeric value beyond which the RDI becomes clinically significant. [Berry et al. 1984] We chose an RDI of 15 or greater as suggestive of at least mild SA as our usual clinical practice is to recommend treat- ment when the RDI exceeds 15. We found that among patients with a low RDI, depressive symptoms were more common. On the other hand, patients with a high RDI were less likely to Sleep & Breathing, 1997; 2 : 74 Schlaf & Atmung

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