Association Between Continuous Positive Airway Pressure Therapy Adherence and Incident Depression Risk in Patients With Obstructive Sleep Apnoea

ABSTRACT Obstructive sleep apnoea (OSA) is associated with major depressive disorder (MDD). However, limited data exist regarding the impact of continuous positive airway pressure (CPAP) on MDD incidence. Data from the Pays de la Loire Cohort were linked to health administrative data to identify incident MDD, defined by antidepressant prescription or hospitalisation for MDD, in patients with no history of psychiatric disorders (depressive, bipolar, psychotic and anxiety disorders) who were prescribed CPAP. Patients with documented CPAP use of at least 4 h per night were compared to those with less than 4 h of use. Cox proportional hazards models were used. After a median follow‐up of 8.45 years, 561 (20.7%) of 2712 patients developed MDD, including 200 (24.2%) in the non‐adherent group ( n = 827) and 361 (19.2%) in the adherent group ( n = 1885). CPAP adherence was associated with a reduced risk of MDD, even after adjusting for age, sex, BMI, socio‐professional factors, insomnia complaint and baseline depressive symptoms (HR = 0.83 [0.70–0.99], p = 0.04). In a population free of prior all psychiatric disorders and treated for OSA with CPAP, adherence to therapy is associated with a lower incidence of MDD. Further studies are warranted to clarify whether non‐adherent patients display vulnerability factors—such as insomnia—that may increase their risk of developing MDD.