Depression is a syndromic diagnosis, characterized by a group of signs and symptoms that represent a heterogeneous set of disorders.
The combination of symptoms can vary in severity and functional impact (ranging from mild to severe), number of episodes (single, recurrent, or chronic), origin (primary, or secondary to other diagnoses such as neurological or hormonal disorders), or comorbidity with other psychiatric conditions.
Investigating sleep is an essential part of a thorough anamnesis. Patients often report alterations in both the quantity and quality of sleep, including difficulties falling asleep, multiple awakenings during the night, terminal insomnia, daytime drowsiness, and persistent fatigue upon waking.
Sleep disturbances may appear before the onset of depressive symptoms, arise as a consequence of depression, or worsen after treatment begins, particularly due to sedative medications.
We know that obstructive sleep apnea is a highly prevalent yet often undiagnosed disorder. It is more common in men than in women. Major risk factors include obesity, family history, anatomical alterations of the upper airways, hyperlipidemia, glucose intolerance, alcohol consumption, smoking, and decreased progesterone levels after menopause.
Individuals with depression have a higher likelihood of presenting with OSA, and conversely, depression is more frequent among patients with obstructive sleep apnea.
What links the two conditions? Several mechanisms have been proposed. Fragmented sleep in OSA, much like depression, causes multiple awakenings and dysregulation of the sympathetic nervous system and the hypothalamic–pituitary–adrenal axis. This leads to inflammation and alters neurotransmitter production. Pharmacological treatments for depression can promote weight gain and worsen metabolic syndromes. In addition, sedatives and antidepressants prescribed to improve sleep may aggravate airway obstruction due to relaxation of the soft palate, leading to snoring and increased airway collapse.
Nowadays, chronic intermittent hypoxia is directly associated with depressive symptoms and cognitive impairments such as attention deficits, daytime vigilance problems, and slower information processing. Its high prevalence makes routine investigation essential.
In the past, polysomnography was available only in specialized labs, limiting access due to the procedure’s complexity. Today, simplified and wireless at-home tests help overcome these barriers. Psychiatrists, therefore, have no excuse to avoid sleep evaluation. They must consider and investigate OSA during the pharmacological treatment of depression in order to recommend appropriate interventions and protect patients’ overall health.
By Dr. Valeria Lauriano – Psychiatrist
Physician - University of São Paulo Medical School
Psychiatrist - IPq HC University of São Paulo Medical School
Ph.D - University of São Paulo Medical School.
CRM [Brazilian Federal Council of Medicine] 61818 RQE 15580
Biologix offers an online platform that allows healthcare practitioners to provide their patients with a simplified and low-cost exam for sleep apnea. The Biologix solution is based on portable sensors, apps, and cloud computing.
The diagnosis of obstructive sleep apnea is extremely important. It can be carried out through polysomnography or the Biologix Sleep Test, a multimodal polysomnography. This test can be performed at home, is simple, practical, effective, and does not require spending the night at a sleep lab.
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