Association between a composite measure of sleep health and depressive symptoms in patients with obstructive sleep apnea treated with CPAP therapy: Real-world data.

OBJECTIVE: Sleep health is known to be multidimensional, and there is increasing clinical interest in composite sleep health scores that capture the number of adverse sleep characteristics. We investigated whether a composite sleep health score was associated with depressive symptoms in patients with obstructive sleep apnea (OSA) treated with continuous positive airway pressure (CPAP). METHODS: Participants were OSA patients using CPAP (n = 1768, (92.1 % men, age 52.7 ± 10.7 years) attending sleep clinics in Japan. A cross-sectional survey conducted in 2020 assessed self-reported sleep and depressive symptoms. Sleep health was categorized as "good' or "poor' on five dimensions: satisfaction, daytime sleepiness, mid-sleep time, efficiency, and duration. A composite sleep health score was calculated by summing the "poor' dimensions. Depressive symptoms were assessed using two items from the Patient Health Questionnaire (PHQ-2). Associations between sleep health and depressive symptoms were assessed using multivariable logistic regression analysis. RESULTS: Individual sleep health symptoms of poor satisfaction and efficiency were significantly associated with depressed mood; poor satisfaction, daytime sleepiness, and duration were significantly associated with loss of interest; and poor satisfaction, efficiency, and duration were significantly associated with depressive symptoms. Composite sleep health scores were associated with greater odds of depressive symptoms in a graded manner. CONCLUSIONS: Individual and composite sleep health scores were associated with depressive symptoms. Measures of multidimensional sleep health may provide a better understanding of the association between poor sleep and depressive symptoms among patients with OSA using CPAP, accounting for CPAP adherence, leading to improved intervention strategies.

A case of Kleine-Levin syndrome arising during chemotherapy: efficacy of oral L-carnitine.

A woman in her 50 s with Kleine-Levin syndrome (KLS) was referred to our sleep clinic for recurrent episodes of sleep hypersomnia lasting for two to 3 days, despite attempts to remain awake. These episodes were unaccompanied by anxiety or depression, increased appetite, increased sex drive, irritability, or hallucinations, and had first appeared during chemotherapy for malignant lymphoma. Video polysomnography revealed mild obstructive sleep apnea syndrome (apnea-hypopnea index 7.9/h), but no other abnormalities. All blood tests and brain imaging investigations, including brain MRI and A 123I-ioflupane SPECT, yielded normal results. Oral L-carnitine was found to be effective for shortening the period of hypersomnolence, reducing the degree of hypersomnolence, and prolonging the inter-episode period. Since it has been reported that alkylating agents may induce carnitine deficiency, the present observations appear to support the involvement of carnitine in the onset of KLS.