Treatment Resistant Depression and Obstructive Sleep Apnea, Effect of Continuous Positive Airway Pressure (CPAP)

• Montgomery Asberg Depression Rating Scale (MADRS)
• HAM-D
• Profile of Mood States (POMS)
• Beck Anxiety Inventory (BAI)
• SF-36 questionnaire

• Symbol digit modalities [ Time Frame: baseline and 6 weeks ] [ Designated as safety issue: No ]
• Stroop Test [ Time Frame: baseline and 6 weeks ] [ Designated as safety issue: No ]
• Trail-Making test [ Time Frame: baseline and 6 weeks ] [ Designated as safety issue: No ]
• Pittsburgh Sleep Quality Index (PSQI) [ Time Frame: baseline and 6 weeks ] [ Designated as safety issue: No ]
• Epworth Sleepiness Score (ESS) [ Time Frame: baseline and 6 weeks ] [ Designated as safety issue: No ]
• Beck Anxiety Inventory (BAI) [ Time Frame: baseline and 6 weeks ] [ Designated as safety issue: No ]
• SF-36 questionnaire [ Time Frame: baseline and 6 weeks ] [ Designated as safety issue: No ]
• Profile of mood state (POMS) [ Time Frame: baseline and 6 weeks ] [ Designated as safety issue: No ]
• HAM-D21 [ Time Frame: baseline and 6 weeks ] [ Designated as safety issue: No ]
  Hamilton depression inventory

• Symbol digit modalities
• STROOP test
• Trail-Making test
• Pittsburgh Sleep Quality Index (PSQI)
• Epworth Sleepiness Score (ESS)

The purpose of the study is to determine the effect on mood and anxiety symptoms of adding CPAP to the psychiatric treatment of patients with TRD (treatment resistant depression) and associated OSA (obstructive sleep apnea).

Primary objective:

What is the effect on mood and anxiety symptoms of adding CPAP to the psychiatric treatment of patients with TRD and associated OSA?

Secondary objectives:

1. How common is co-morbid OSA in patients with treatment resistant unipolar depression referred to a tertiary Mood Disorders Clinic?
2. Is there a difference in daytime functioning (severity of depressive and anxiety symptoms, cognitive function, daytime sleepiness) and sleep quality between patients with TRD diagnosed with OSA compared with patients with TRD who have no OSA?
3. What is the association between sleep fragmentation and hypoxemia and the severity of depression in patients with TRD?

• Depression
• Sleep Apnea, Obstructive

• Experimental: CPAP treatment
  Continuous Positive Airway Pressure (CPAP)for 4 weeks
  Intervention: Device: continuous positive airway pressure (CPAP)
• No Intervention: No CPAP
  routine psychiatric care for 4 weeks followed by CPAP titration and initiation after followup measures.
• No Intervention: Control group
  No obstructive sleep apnea detected.

Inclusion Criteria:

• Patients with TRD.
• Males and females between the ages of 18 and 65 years who agree to take part and sign the Informed Consent will be invited to participate in the study.
• Patients with co-morbid Dysthymic Disorder, Generalized Anxiety Disorder or Social Anxiety Disorder may be included in the study.

Exclusion Criteria:

• Patients with uncontrolled medical illnesses will not be permitted to participate.
• Patients with a history of current or Bipolar Disorder, Schizophrenia, Panic Disorder, Obsessive-Compulsive Disorder or Anorexia Nervosa.
• Head injury patients resulting in loss of consciousness for more than 10 minutes.
• Patients with epilepsy or severe personality disorders who, at the judgment of the investigators, are not appropriate candidates for the study, will be excluded.
• Patients who do not have the mental or physical capacity to apply the CPAP interface and to plug in and switch on an auto CPAP unit at home will be excluded.
• Blind and/or deaf patients will be excluded.
• Patients who initially decline an offer of CPAP treatment for OSA, and those who prefer conservative treatment options (weight loss, avoidance of alcohol and sedatives) will be excluded.
• Patients with severe claustrophobia, who cannot tolerate any CPAP interface, will be excluded.