The Relationship Between Sleep Apnoea and Psychological Distress

Grayling, Jennifer and Bourne, Katy and Perez Algorta, Guillermo (2024) The Relationship Between Sleep Apnoea and Psychological Distress. PhD thesis, Lancaster University.

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Abstract

The reciprocal relationship between sleep and mental health is well-recognised. Yet, research in this area remains scarce, and as a result, clinical practice often overlooks this association, particularly in the context of sleep apnoea. Therefore, this thesis aimed to clarify the psychological implications of sleep apnoea and explore the barriers to treatment from a psychological perspective. Section 1 is a scoping review of the current literature documenting an association between sleep apnoea and suicidality. Twenty-four papers were reviewed. Articles were included irrespective of quality, to provide a broad overview of the evidence-base. The review suggested an increased risk of suicidality in individuals with sleep apnoea and suggested preliminary evidence for the importance of continuous positive airway pressure (CPAP) in reducing this. The findings underscored the need for clinical psychologists to monitor mental health in individuals with sleep apnoea. Additionally, the review emphasised current gaps within the literature and provided a focus for future research. Section 2 is an empirical research study investigating the impact of psychological distress on adherence to CPAP in people with Obstructive Sleep Apnoea (OSA). The first 28-days of CPAP usage of 47 individuals with OSA were monitored. Participants completed questionnaires measuring depression, anxiety, stress, and claustrophobia. Regression analyses revealed that depression was predictive of both frequency, and duration of CPAP usage. The findings suggest the importance of targeting psychological distress in interventions designed to improve CPAP adherence. However, the small sample size limits the findings; thus, future research is necessary. Section 3 is a critical appraisal and summary of the review and empirical paper. Ethical issues and challenges experienced throughout are discussed, in addition to avenues for future research. Consideration is given to the under estimation of sleep, and the complex relationship that exists between sleep apnoea and psychological distress brought to light by this thesis.