Mood Disorders are Correlated with Autonomic Nervous Function in Chronic Insomnia Patients with OSA

Figures & data

Table 1 Demographics of the Participants and Neuropsychological Evaluations of Three Group Patients

	HCs Group (n=22) (A)	CI Group (n=46) (B)	CI with OSA Group (n=45) (C)	p
Age, year	51.78±11.80	54.65±11.43	57.09±7.25	NS
Male, n (%)	7 (31.8%)	21 (45.7%)	19 (42.2%)	NS
Education, year	13.96±2.01	12.87±3.32	12.58±3.46	NS
Smoke, n (%)	3 (13.6%)	6 (13.0%)	11 (24.4%)	NS
BMI, kg/m2	23.01±1.96	23.43±2.46	24.58±3.83	NS
Hypertension, n (%)	3 (13.6%)	8 (17.4%)	15 (33.3%)	NS
Diabetes, n (%)	1 (4.5%)	7 (15.2%)	7 (15.6%)	NS
Hyperlipemia, n (%)	4 (18.2%)	3 (6.5%)	6 (13.3%)	NS
HAMA	3.82±2.44	9.15±3.82	11.91±2.75	A<B**, A<C**, B<C**
HAMD	3.73±2.35	8.98±2.95	11.56±2.88	A<B**, A<C**, B<C**
MMSE	29.73±0.63	28.31±1.64	27.35±1.38	A<B**, A<C**, B<C**

Notes: Plus‐minus values are means ± SD. **p < 0.01.

Abbreviations: HCs, healthy control subjects; CI, chronic insomnia; CI-OSA, chronic insomnia patients with OSA; HAMD, Hamilton Depression Scales; HAMA, Hamilton Anxiety Scales; MMSE, Mini-Mental State Examination.

Table 2 Demographics of the Participants and Neuropsychological Evaluations of the CI-Mild OSA Patients and CI- Moderate-to-Severe OSA Patients

	CI-Mild OSA Group (AHI<15, n=27)	CI-Moderate to Severe OSA Group (AHI≥15, n=18)	P
Age, year	57.70±6.91	56.17±7.84	0.492
Male, n (%)	10 (37.0%)	9 (50.0%)	0.388
Education, year	12.33±3.59	12.94±3.32	0.568
Smoke, n (%)	6 (22.2%)	5 (27.8%)	0.671
BMI, kg/m2	23.97±3.51	25.50±4.19	0.191
Hypertension, n (%)	7 (25.9%)	8 (44.4%)	0.197
Diabetes, n (%)	6 (22.2%)	1 (5.6%)	0.131
Hyperlipemia, n (%)	5 (18.5%)	1 (5.6%)	0.210
HAMA	11.11±2.47	13.11±2.78	0.015
HAMD	10.67±2.35	12.89±3.14	0.010
MMSE	27.52±1.45	27.11±2.27	0.466

Note: Plus‐minus values are means ± SD.

Abbreviations: HCs, healthy control subjects; CI, chronic insomnia; CI-OSA, chronic insomnia patients with OSA; HAMD, Hamilton Depression Scales; HAMA, Hamilton Anxiety Scales; MMSE, Mini-Mental State Examination.

Table 3 Objective and Subjective Sleep Characteristics of the Three Groups Patient

	HCs Group (n=22) (A)	CI Group (n=46) (B)	CI with OSA Group (n=45) (C)	P
Objective evaluation
Unstable sleep,%	43.64±13.30	55.23±13.03	62.62±11.05	A<B**, A<C**, B<C*
Stable sleep,%	32.06±12.89	21.86±12.80	15.95±10.48	A>B**, A>C**, B>C*
REM sleep,%	24.31±2.22	22.91±2.74	21.43±2.35	A>C**, B>C*
AHI	1.92±1.56	1.94±1.31	15.01±13.33	A<C**, B<C**
Mean oxygen saturation	96.77±0.53	96.02±0.58	94.80±0.89	A>C**, B>C*
PSQI	4.00±1.95	12.72±3.62	12.13±3.27	A<B**, A<C**
ESS	0.32±0.95	0.61±1.29	2.58±3.03	A<C**, B<C**
ISI	2.05±2.66	13.04±5.00	12.91±4.61	A<B**, A<C**

Notes: Plus‐minus values are means ± SD. *p < 0.05; **p < 0.01.

Abbreviations: REM, rapid eye movement; AHI, apnea‐hypopnea index; PSQI, Pittsburgh Sleep Quality Index; ESS, Epworth Sleepiness Scale; ISI, Insomnia Severity Index.

Table 4 Objective and Subjective Sleep Characteristics of the CI-Mild OSA Patients and CI- Moderate-to-Severe OSA Patients

	CI-Mild OSA Group (AHI<15, n=27)	CI-Moderate to Severe OSA Group (AHI≥15, n=18)	P
Objective evaluation
Unstable sleep,%	59.45±10.21	67.38±10.80	0.017
Stable sleep,%	18.52±9.55	12.10±10.90	0.043
REM sleep,%	22.03±2.04	20.52±2.55	0.033
AHI	8.40 (5.50, 11.90)	15.85 (15.18, 27.83)	<0.001
Mean oxygen saturation	95.19±0.74	94.22±0.81	<0.001
PSQI score	12.85±3.58	11.06±2.44	0.052
ESS score	1.22±1.97	4.61±3.24	0.001
ISI score	13.89±5.32	11.44±2.81	0.052

Note: Plus‐minus values are means ± SD.

Abbreviations: REM, rapid eye movement; AHI, apnea‐hypopnea index; PSQI, Pittsburgh Sleep Quality Index; ESS, Epworth Sleepiness Scale; ISI, Insomnia Severity Index.

Table 5 Autonomic Nervous Function of the Three Groups Patients

	HCs Group (n=22) (A)	CI Group (n=46) (B)	CI with OSA Group (n=45) (C)	p
HR	63.05±7.54	63.59±8.57	65.47±8.58	NS
LF	54.45±11.66	64.06±13.53	69.81±9.94	A<B**, A<C**, B<C*
HF	45.55±11.65	35.94±13.53	30.19±9.94	A>B**, A>C**, B>C*
LF/HF	1.33±0.55	2.18±1.20	2.67±1.19	A<B**, A<C**, B<C*
SDNN	78.28±1955	74.50±25.38	72.92±21.16	NS
RMSSD	33.25 (26.68, 44.78)	28.25 (22.15, 40.61)	27.00 (23.60, 33.75)	NS
Pnn 50%	11.18 (5.51, 23.09)	5.67 (3.39, 14.06)	3.90 (1.87, 7.53)	A<B*, A<C**

Notes: Plus‐minus values are means ± SD. *p < 0.05; **p < 0.01.

Abbreviations: LF, low-frequency coupling; HF, high-frequency coupling; SDNN, standard deviation of NN intervals; RMSSD, square root of the mean squared differences of successive NN intervals; Pnn50%, the percentage of NN intervals>50ms different from preceding interval.

Table 6 Autonomic Nervous Function of the CI-Mild OSA Patients and CI- Moderate-to-Severe OSA Patients

	CI-Mild OSA Group (AHI<15, n=27)	CI-Moderate to Severe OSA Group (AHI≥15, n=18)	p
HR	63.41±8.68	68.56±7.65	0.047
LF	67.31±10.61	73.55±7.67	0.038
HF	32.69±10.61	26.45±7.67	0.038
LF/HF	2.39±1.16	3.07±1.13	0.059
SDNN	73.89±22.11	71.48±20.21	0.714
RMSSD	27.00 (24.30, 30.00)	27.50 (22.98, 38.00)	0.487
Pnn 50%	4.53 (1.81, 7.68)	3.74 (2.40, 5.37)	0.711

Note: Plus‐minus values are means ± SD.

Abbreviations: LF, low-frequency coupling; HF, high-frequency coupling; SDNN, standard deviation of NN intervals; RMSSD, square root of the mean squared differences of successive NN intervals; Pnn50%, the percentage of NN intervals>50ms different from preceding interval.

Figure 1 Correlation between autonomic nervous function and severity of depressive and anxiety in the CI-OSA group. The MMSE scores showed a negative correlation HAMD scores (r=−0.678, p < 0.01) (A). The HAMD and HAMA scores showed a positive correlation with LF ratio (r=0.321, p =0.031; r =0.449, p =0.002) (B and C) and a negative correlation with HF ratio (r=−0.321, p =0.031; r =−0.449, p =0.002) (D and E). And the HAMA scores showed a positive correlation with LF/HF ratio (r=0.434, P =0.003) (F).

Figure 2 Linear regression of autonomic nervous function and severity of depressive and anxiety in the CI-OSA group. (A and C) Increased LF ratio and decreased HF ratio in the CI-OSA patients were independently associated with HAMD scores (R²=0.3750, p<0.0001); (B and D) Increased LF ratio and decreased HF ratio in the CI-OSA patients were independently associated with HAMA scores (R²=0.4594, p<0.0001).