Simultaneous use of antidepressant and antihypertensive medications increases likelihood of diagnosis of obstructive sleep apnea syndrome.

Intermountain Sleep Disorders Center, LDS Hospital, Salt Lake City, UT 84143, USA.
Chest (Impact Factor: 7.48). 04/2004; 125(4):1279-85.
Source: PubMed


Essential hypertension and symptoms of depression such as unexplained fatigue and tiredness are frequently encountered in primary medical care clinics. Although, exhaustive evaluation rarely detects unsuspected underlying disorders, obstructive sleep apnea (OSA) is commonly associated with each of these conditions. We tested the hypothesis that therapy with antihypertensive and antidepressant medications predicts the increased likelihood of OSA.
We analyzed the computer archive of 212,972 patients for prescriptions for antihypertensive medications, antidepressant medications, and International Classification of Diseases, Ninth Revision codes for OSA. Prevalence, prevalence odds ratio (POR), and confidence intervals (CIs) were calculated correcting for gender and age group.
The prevalence rates of OSA were 0.8%, 2.8%, and 3.2% for men and 0.4%, 1.4%, and 1.8% for women aged 20 to 39 years, 40 to 59 years, and >or= 60 years, respectively. Compared to groups of corresponding age and gender who had not received prescriptions for either hypertension or depression, the highest PORs were found in patients receiving medications from both categories: 18.30 (95% CI, 10.69 to 25.66), 5.72 (95% CI, 4.10 to 6.70), and 4.47 (95% CI, 2.45 to 7.01) for men, and 17.43 (95% CI, 9.54 to 28.67), 7.29 (95% CI, 5.20 to 9.29), and 2.72 (95% CI, 1.48 to 4.73) for women.
We found that the likelihood of having a diagnosis of OSA increases when either antihypertensive or antidepressant medications have been prescribed. The probability is highest in the young and middle-age groups receiving prescriptions for both medications. The possibility of OSA should be considered in any patient with hypertension and depression or unexplained fatigue who is receiving antihypertensive and antidepressant medications.

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    • "a OSA defined as an apneaehypopnea index of five or more per hour. psychiatric patients, data on the associations between blood pressure and OSA are few and conflicting (Ohayon, 2003; Farney et al., 2004; Shirani et al., 2011; Anderson et al., 2012), and in one study (Shirani et al., 2011) no association between diabetes and OSA was found. In our study, type 2 diabetes was not associated with OSA, whereas hypertension was associated with OSA independently of age, gender, BMI, and snoring. "
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    ABSTRACT: Tese (doutorado)—Universidade de Brasília, Faculdade de Ciências da Saúde, 2007. Objetivo: Investigar a prevalência de transtorno depressivo maior em pacientes hipertensos matriculados em um centro de referência universitário para tratamento de hipertensão arterial e outros fatores de risco cardiovasculares. Métodos: estudo transversal, descritivo, em amostra aleatória representativa obtida de forma sistemática de pacientes em atendimento contínuo na Liga de Hipertensão Arterial da Universidade Federal de Goiás. Aplicou-se o Inventário de Depressão de Beck (BDI) para rastreamento de sintomas depressivos e a entrevista estruturada SCID I/P-DSM-IV para avaliação diagnóstica de transtorno depressivo maior. Foram constituídos um grupo com pacientes portadores de depressão maior, denominado grupo estudo (GE) e um grupo com pacientes não portadores de depressão maior, denominado grupo controle (GC). Variáveis sócio-demográficas, pressão arterial e bioquímica sanguínea foram avaliadas no momento da coleta de dados. Resultados: Foram entrevistados 285 pacientes tendo sido encontrada prevalência de 20% de depressão maior na população investigada. A idade média foi significativamente menor para o GE, com predomínio do sexo feminino. A prática de atividade física regular foi também significativamente menor entre os pacientes do GE que também apresentaram valores mais elevados de pressão arterial diastólica e de colesterolemia. Conclusão: Foi encontrada uma prevalência de Transtorno Depressivo Maior em pacientes hipertensos superior àquela encontrada na população geral, além de dados consistentes quanto a maior nível de pressão arterial diastólica, colesterolemia e menor realização de atividade física entre indivíduos do Grupo Estudo. Isso aponta para uma necessidade de maior atenção para o diagnóstico dos transtornos depressivos em pacientes hipertensos em atendimento primário e ambulatorial. _________________________________________________________________________________________ ABSTRACT Objective: Investigating the prevalence of major depression disorders in hypertensive patients enrolled in a university reference center for the treatment of hypertension and other cardiovascular risk factors. Methods: cross-sectional, descriptive study of a representative randomized sample of patients, obtained according to a systematic protocol, among individuals enrolled for continuous treatment at the Hypertension League of the Universidade Federal de Goiás. The Beck Depression Inventory (BDI) was administered for detecting the depressive symptoms, and the SCID I/P-DSM-IV structured interview, for the diagnostic classification of the major depressive disorder. Two groups were formed, one with patients with major depressive disorder, called study group (SG) and another with patients without depression, called control group (CG). Sociodemographic variables, blood pressure and plasma biochemistry were evaluated at the time of the interview. Results: From the two-hundred eighty-five patients who were evaluated the results indicated a 20% prevalence of major depression in the population included in the study. The mean age was significantly lower for the SG, where female individuals were predominant. Regular physical activity was less common among patients in the SG; and higher diastolic blood pressure values as well as cholesterolemia were also found in this group. Conclusion: these results show a higher prevalence of major depressive disorder among these patients, relative to the population as a whole. More attention should be paid to establishing an adequate diagnosis for depressive disorders in hypertensive patients, both in primary care facilities and in outpatient clinics.
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