Depressive symptoms in patients with obstructive sleep apnea: biological mechanistic pathways

Diana Andrea Chirinos Medina*, Indira Gurubhagavatula, Preston Broderick, Julio A. Chirinos, Karen Teff, Thomas Wadden, Greg Maislin, Hassam Saif, Jesse Chittams, Caitlin Cassidy, Alexandra L. Hanlon, Allan I. Pack

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

7 Scopus citations


This study examined the association between depressive symptoms, as well as depressive symptom dimensions, and three candidate biological pathways linking them to Obstructive sleep apnea (OSA): (1) inflammation; (2) circulating leptin; and (3) intermittent hypoxemia. Participants included 181 obese adults with moderate-to-severe OSA enrolled in the Cardiovascular Consequences of Sleep Apnea (COSA) trial. Depressive symptoms were measured using the Beck Depression Inventory-II (BDI-II). We assessed inflammation using C-reactive protein levels (CRP), circulating leptin by radioimmunoassay using a double antibody/PEG assay, and intermittent hypoxemia by the percentage of sleep time each patient had below 90% oxyhemoglobin saturation. We found no significant associations between BDI-II total or cognitive scores and CRP, leptin, or percentage of sleep time below 90% oxyhemoglobin saturation after controlling for relevant confounding factors. Somatic symptoms, however, were positively associated with percentage of sleep time below 90% saturation (β = 0.202, P = 0.032), but not with CRP or circulating leptin in adjusted models. Another significant predictor of depressive symptoms included sleep efficiency (βBDI Total = −0.230, P = 0.003; βcognitive = −0.173, P = 0.030 (βsomatic = -0.255, P = 0.001). In patients with moderate-to-severe OSA, intermittent hypoxia may play a role in somatic rather than cognitive or total depressive symptoms.

Original languageEnglish (US)
Pages (from-to)955-963
Number of pages9
JournalJournal of Behavioral Medicine
Issue number6
StatePublished - Dec 1 2017


  • C-reactive protein
  • Depression
  • Inflammation
  • Insomnia
  • Leptin
  • Obstructive sleep apnea

ASJC Scopus subject areas

  • Psychiatry and Mental health
  • Psychology(all)


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