Dream anxiety levels in patients with obstructive sleep apnea syndrome

Objective: Obstruction of the upper airway may cause intermittent oxygen desaturation in the blood leading to interruption of sleep which may manifest in repeated episodes of Obstructive Sleep Apnea Hypopnea Syndrome (OSAHS). OSAHS patients have dreams including negative emotions. MacFarlane et al. have shown that a high proportion (66%) of patients with OSAHS have reported nightmares “sometimes”. Thus we aimed to study the relation between dream anxiety level and patients’ OSAHS severity and a correlation between dream anxiety level and depression and/or anxiety levels in patients with OSAHS that might be present.

Method: Ninety-three patients with OSAHS were recruited in the department of Chest Disease at the Medical School of Cerrahpasa from January to December in 2013. We used the Van Dream Anxiety Scale, Hospital anxiety and depression scale, Epworth Sleepiness Scale and then had polysomnography performed. One-way ANOVA test was used within subgroups of patients with OSAHS and then Bonferroni correction was made; a p value <0.0125 was accepted as significant.

Results: The mean age was 49.49±13.60 years and there was no significant difference according to age between groups: simple snoring (48.29±17.06), mild OSAHS (54.57±10.52), moderate OSAHS (50.24±13.98), severe OSAHS (47.70±11.02), F=0.929 and p=0.430. The mean Hospital Anxiety and Depression (HAD) score of patients was 15.93±7.09 points and was significantly different between groups (p=0.022). The mean Van Dream Anxiety Scale score was 6.50±8.17 points in patients and no difference was detected according to VDAS between groups (χ2=2.736 and p=0.434). The mean Epworth’s score was 7.62±4.8 and was significantly different between groups (χ2=13.47 and p=0.004). Patients from the severe OSAHS group have a significantly worse sleep quality than those in the simple snoring group (p=0.001). We found a positive correlation between HADS and VDAS score (r=326 and p=0.002). There was a negative correlation between basal O2 saturation of patients and VDAS score (r=218 and p=0.037).

Conclusion: This study is the first that investigated patients’ OSAHS severity in association with VDAS for dream anxiety. In the present study, we have found negative correlations between dream anxiety level according to VDAS and duration and density of REM sleep, and baseline O2 level according to polysomnography. It is known that dream recall is more frequent in people who have higher proportions of REM. Thus, we considered that although patients with OSAHS accepted to have frequent nightmares, anxiety in patients with OSAHS might also contribute to these frequent nightmares. We think that the treatment with CPAP might also decrease anxiety levels in patients with severe OSAHS.