Antihypertensive, Antidepressant Use Can Be Marker for Sleep Problems
April 23, 2004
By Megan Rauscher

NEW YORK (Reuters Health) - Patients treated with an antihypertensive and/or antidepressant drug have an increased likelihood of being diagnosed with obstructive sleep apnea (OSA), researchers from Utah report in the April issue of the journal Chest.

The possibility of OSA "must be at least considered" in any patient receiving one or both of these medications, suggest Dr. Robert J. Farney and colleagues from LDS Hospital in Salt Lake City.

"Everybody knows that hypertension and sleep apnea are connected," Dr. Farney noted in a telephone interview with Reuters Health. "But when a colleague pointed out that so many of the patients coming in for evaluation of sleep apnea are being treated not only for hypertension but also for so-called depression, we decided to do this study."

Dr. Farney's team reviewed computerized records of 212,972 patients for prescriptions for BP-lowering and antidepressant medications as well as a clinical diagnosis of OSA.

"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 60 or older, respectively," they write.

According to the team, "the prevalence of OSA increased with prescriptions for either an antidepressant or antihypertensive medication or both." The highest prevalence for OSA was seen in 40- to 59-year-olds taking both an antidepressant and antihypertensive, at 10.0% in men and 5.38% in women.

The team also calculated the prevalence odds ratio (POR). Among their findings were that men the 20-to-39 age bracket taking an antihypertensive, antidepressant, or both had a 6.84, 4.12, and 18.30 times greater probability of having OSA, respectively, compared with men in the same age group not receiving these medications. Similar patterns and trends were observed in women.

The tie between antihypertensive and antidepressant medication and OSA is "predictable," the team writes; "however the magnitude of this relationship was striking and not anticipated, particularly in the young, in whom the frequency of sleep apnea is low."

Dr. Farney's advice: When you have patient who is fatigued, hypertensive, and on something for hypertension and depression, "no matter what their age, you ought to think of the possibility of sleep apnea regardless of their body type. What most physicians don't realize is that not all patients with sleep apnea are fat 50-year-old guys. You may have a young thin female."

'Many times," he added, "hypertension, depression, and fatigue resolve once you get them treated correctly for their sleep apnea."

Chest 2004;125:1279-1285.