Serotonergic antidepressant use following positive airway pressure initiation

Introduction — Some previous research has demonstrated that treatment of obstructive sleep apnea (OSA) improves depression and anxiety symptoms, but whether treating OSA translates into a reduction in antidepressant drug use is uncertain. We evaluated the impact of initiating incident positive airway pressure (PAP) therapy on serotonergic antidepressant discontinuation among chronic drug users.

Methods — We used a population-based, retrospective cohort design, analyzing Ontario health administrative data from January 1, 2010-December 31, 2019. Ontarians ages 65 years of age and older, who were chronic serotonergic antidepressant users, were included. Our main analysis evaluated the association between new PAP receipt and serotonergic antidepressant drug discontinuation between 6 and 12 months post-PAP initiation. To minimize confounding, we used propensity score matching to account for potential differences in 49 relevant covariates between new and non-PAP users.

Results — We identified 181,639 chronic serotonergic antidepressant users, of whom 6.3% newly received PAP. In our matched cohort, we found that new vs. non-PAP users had significantly lower rate of serotonergic antidepressant discontinuation at the 6-12 month mark (6.2% vs. 9.0%, relative risk [RR] 0.69, 95% confidence interval [CI] 0.62-0.77). Similar findings were observed when considering a more distant follow-up period of 12-18 months post-PAP initiation (8.4% vs. 12.6%, RR 0.67, 95% CI 0.61-0.73).

Conclusions — Relative to non-PAP use, new PAP receipt was associated with significantly lower rates of serotonergic antidepressant discontinuation among chronic drugs users. Further research is required to determine the causation of this unanticipated finding.