{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,30]],"date-time":"2026-10-30T18:08:13Z","timestamp":1793383693347,"version":"4.5.0"},"reference-count":39,"publisher":"MDPI AG","issue":"9","license":[{"start":{"date-parts":[[2022,4,20]],"date-time":"2022-04-20T00:00:00Z","timestamp":1650412800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100001691","name":"Japan Society for the Promotion of Science","doi-asserted-by":"publisher","award":["21H03851"],"award-info":[{"award-number":["21H03851"]}],"id":[{"id":"10.13039\/501100001691","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["IJERPH"],"abstract":"<jats:p>Background: Multiple clinical departments are involved in the provision of obstructive sleep apnoea (OSA) therapy in Japan. Inconsistent results regarding the association between depression and OSA have been reported. Methods: This cross-sectional survey compared newly diagnosed OSA patients at two outpatient sleep apnoea units in Shiga Prefecture, Japan: one associated with the psychiatry department (n = 583), and the other with the otolaryngology department (n = 450). Results: The unit associated with the psychiatry department had more patients referred by psychiatrists than that with the otolaryngology department (11% vs. 3% p &lt; 0.05). Sleepiness, insomnia, and depression were assessed using the Epworth Sleepiness Scale (ESS), Athens Insomnia Scale (AIS), and Patient Health Questionnaire-9 (PHQ-9), respectively. The ESS, AIS, and PHQ-9 scores were higher in the sleep unit in the psychiatry department (p &lt; 0.001 each). Snoring and moderate to severe OSA were more prevalent in the unit attached to the otolaryngology department (p &lt; 0.001 each). Patients with moderate to severe OSA had lower PHQ-9 scores than those with no to mild OSA (OR: 0.96, 95% CI: 0.92\u20131.00, p = 0.042). Conclusion: Patients with sleepiness, insomnia, and depressive symptoms were more likely to attend a sleep outpatient unit associated with a psychiatry department, whereas those with snoring and sleep apnoea attended that associated with an otolaryngology department. OSA severity was negatively associated with depressive symptoms.<\/jats:p>","DOI":"10.3390\/ijerph19095007","type":"journal-article","created":{"date-parts":[[2022,4,21]],"date-time":"2022-04-21T01:55:51Z","timestamp":1650506151000},"page":"5007","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Obstructive Sleep Apnoea Severity Is Negatively Associated with Depressive Symptoms: A Cross-Sectional Survey of Outpatients with Suspected Obstructive Sleep Apnoea in Japan"],"prefix":"10.3390","volume":"19","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0261-1003","authenticated-orcid":false,"given":"Kazuki","family":"Ito","sequence":"first","affiliation":[{"name":"Department of Anesthesiology, Shiga University of Medical Science, Seta-Tsukinowa-Cho, Otsu 520-2192, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Masahiro","family":"Uetsu","sequence":"additional","affiliation":[{"name":"Sleep Outpatient Unit for Sleep Apnea Syndrome, Nagahama City Hospital, 313 Ohinui-Cho, Nagahama 526-0043, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4966-6703","authenticated-orcid":false,"given":"Ayaka","family":"Ubara","sequence":"additional","affiliation":[{"name":"Department of Psychiatry, Shiga University of Medical Science, Seta-Tsukinowa-Cho, Otsu 520-2192, Japan"},{"name":"Graduate School of Psychology, Doshisha University, Kyoto 610-0394, Japan"},{"name":"Japan Society for the Promotion of Science, Research Fellowships, Tokyo 102-0083, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Arichika","family":"Matsuda","sequence":"additional","affiliation":[{"name":"Department of Psychiatry, Shiga University of Medical Science, Seta-Tsukinowa-Cho, Otsu 520-2192, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6775-0883","authenticated-orcid":false,"given":"Yukiyoshi","family":"Sumi","sequence":"additional","affiliation":[{"name":"Department of Psychiatry, Shiga University of Medical Science, Seta-Tsukinowa-Cho, Otsu 520-2192, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7474-3315","authenticated-orcid":false,"given":"Hiroshi","family":"Kadotani","sequence":"additional","affiliation":[{"name":"Sleep Outpatient Unit for Sleep Apnea Syndrome, Nagahama City Hospital, 313 Ohinui-Cho, Nagahama 526-0043, Japan"},{"name":"Department of Psychiatry, Shiga University of Medical Science, Seta-Tsukinowa-Cho, Otsu 520-2192, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2022,4,20]]},"reference":[{"key":"ref_1","unstructured":"American Academy of Sleep Medicine (2014). International Classification of Sleep Disorders, American Academy of Sleep Medicine. [3rd ed.]."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"5","DOI":"10.1007\/s41105-021-00353-6","article-title":"Sleep Apnea Syndrome (SAS) Clinical Practice Guidelines 2020","volume":"60","author":"Akashiba","year":"2022","journal-title":"Sleep Biol. Rhythm."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"687","DOI":"10.1016\/S2213-2600(19)30198-5","article-title":"Estimation of the Global Prevalence and Burden of Obstructive Sleep Apnoea: A Literature-Based Analysis","volume":"7","author":"Benjafield","year":"2019","journal-title":"Lancet Respir. Med."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"419","DOI":"10.1093\/sleep\/31.3.419","article-title":"Sleep-disordered breathing in the usual lifestyle setting as detected with home monitoring in a population of working men in Japan","volume":"31","author":"Nakayama","year":"2008","journal-title":"Sleep"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"335","DOI":"10.5664\/jcsm.7640","article-title":"Treatment of Adult Obstructive Sleep Apnea with Positive Airway Pressure: An American Academy of Sleep Medicine Clinical Practice Guideline","volume":"15","author":"Patil","year":"2019","journal-title":"J. Clin. Sleep Med."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"93","DOI":"10.1007\/s11325-006-0087-5","article-title":"Demographic Characteristics of 3,659 Japanese Patients with Obstructive Sleep Apnea-Hypopnea Syndrome Diagnosed by Full Polysomnography: Associations with Apnea-Hypopnea Index","volume":"11","author":"Ohdaira","year":"2007","journal-title":"Sleep Breath."},{"key":"ref_7","doi-asserted-by":"crossref","unstructured":"Okuno, K., Furuhashi, A., Nakamura, S., Suzuki, H., Arisaka, T., Taga, H., Tamura, M., Katahira, H., Furuhata, M., and Iida, C. (2019). Japanese Cross-Sectional Multicenter Survey (JAMS) of Oral Appliance Therapy in the Management of Obstructive Sleep Apnea. Int. J. Environ. Res. Public Health, 16.","DOI":"10.3390\/ijerph16183288"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"9","DOI":"10.1186\/s41606-017-0010-y","article-title":"Comparison of Self-Reported Scales and Structured Interviews for the Assessment of Depression in an Urban Male Working Population in Japan: A Cross-Sectional Survey","volume":"1","author":"Kadotani","year":"2017","journal-title":"Sleep Sci. Pract."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"441","DOI":"10.1111\/j.1440-1819.2005.01397.x","article-title":"Twelve-Month Prevalence, Severity, and Treatment of Common Mental Disorders in Communities in Japan: Preliminary Finding from the World Mental Health Japan Survey 2002\u20132003","volume":"59","author":"Kawakami","year":"2005","journal-title":"Psychiatry Clin. Neurosci."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"573","DOI":"10.4103\/1119-3077.188703","article-title":"Evaluation of Depression and Quality of Life in Patients with Obstructive Sleep Apnea Syndrome","volume":"19","author":"Yosunkaya","year":"2016","journal-title":"Niger. J. Clin. Pract."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"1029","DOI":"10.5664\/jcsm.5020","article-title":"Depressive Symptoms Before and After Treatment of Obstructive Sleep Apnea in Men and Women","volume":"11","author":"Edwards","year":"2015","journal-title":"J. Clin. Sleep Med."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"346","DOI":"10.4103\/jnrp.jnrp_462_16","article-title":"Depression as a Manifestation of Obstructive Sleep Apnea","volume":"8","author":"Shoib","year":"2017","journal-title":"J. Neurosci. Rural Pract."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"575","DOI":"10.5664\/jcsm.6546","article-title":"Associations of Undiagnosed Obstructive Sleep Apnea and Excessive Daytime Sleepiness with Depression: An Australian Population Study","volume":"13","author":"Lang","year":"2017","journal-title":"J. Clin. Sleep Med."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"45","DOI":"10.1016\/j.maturitas.2020.06.002","article-title":"Obstructive Sleep Apnea and Depression: A Systematic Review and Meta-Analysis","volume":"142","author":"Edwards","year":"2020","journal-title":"Maturitas"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"751","DOI":"10.1016\/j.chest.2020.03.049","article-title":"Efficacy of CPAP for Improvements in Sleepiness, Cognition, Mood, and Quality of Life in Elderly Patients with OSA: Systematic Review and Meta-Analysis of Randomized Controlled Trials","volume":"158","author":"Labarca","year":"2020","journal-title":"Chest"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"615","DOI":"10.1007\/s11325-012-0731-1","article-title":"Depressive Symptoms in Patients with Obstructive Sleep Apnea\/Hypopnea Syndrome","volume":"17","year":"2013","journal-title":"Sleep Breath."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"2168","DOI":"10.1111\/jsm.13021","article-title":"Low Quality of Life and Depressive Symptoms as an Independent Risk Factor for Erectile Dysfunction in Patients with Obstructive Sleep Apnea","volume":"12","author":"Jeon","year":"2015","journal-title":"J. Sex. Med."},{"key":"ref_18","doi-asserted-by":"crossref","unstructured":"Macey, P.M., Woo, M.A., Kumar, R., Cross, R.L., and Harper, R.M. (2010). Relationship Between Obstructive Sleep Apnea Severity and Sleep, Depression and Anxiety Symptoms in Newly-Diagnosed Patients. PLoS ONE, 5.","DOI":"10.1371\/journal.pone.0010211"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"e12647","DOI":"10.1111\/jsr.12647","article-title":"Increased Severity of Obstructive Sleep Apnea Is Associated with Less Anxiety and Depression","volume":"27","author":"Bjorvatn","year":"2018","journal-title":"J. Sleep Res."},{"key":"ref_20","first-page":"939","article-title":"Simple Four-Variable Screening Tool for Identification of Patients with Sleep-Disordered Breathing","volume":"32","author":"Takegami","year":"2009","journal-title":"Sleep"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"556","DOI":"10.1016\/j.sleep.2008.04.015","article-title":"Development of a Japanese Version of the Epworth Sleepiness Scale (JESS) Based on Item Response Theory","volume":"10","author":"Takegami","year":"2009","journal-title":"Sleep Med."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"57","DOI":"10.1016\/j.smrv.2016.10.004","article-title":"Diagnostic accuracy of the Berlin questionnaire, STOP-BANG, STOP and Epworth sleepiness scale in detecting obstructive sleep apnea: A bivariate meta-analysis","volume":"36","author":"Chiu","year":"2017","journal-title":"Sleep Med. Rev."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"479","DOI":"10.5664\/jcsm.6506","article-title":"Clinical Practice Guideline for Diagnostic Testing for Adult Obstructive Sleep Apnea: An American Academy of Sleep Medicine Clinical Practice Guideline","volume":"13","author":"Kapur","year":"2017","journal-title":"J. Clin. Sleep Med."},{"key":"ref_24","doi-asserted-by":"crossref","unstructured":"Ito, K., Uetsu, M., and Kadotani, H. (2020). Validation of Oximetry for Diagnosing Obstructive Sleep Apnea in a Clinical Setting. Clocks Sleep, 2.","DOI":"10.3390\/clockssleep2030027"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"79","DOI":"10.1016\/j.smrv.2016.01.007","article-title":"Craniofacial and Upper Airway Morphology in Adult Obstructive Sleep Apnea Patients: A Systematic Review and Meta-Analysis of Cephalometric Studies","volume":"31","author":"Neelapu","year":"2017","journal-title":"Sleep Med. Rev."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"303","DOI":"10.5664\/jcsm.8188","article-title":"Utility of the Modified Mallampati Grade and Friedman Tongue Position in the Assessment of Obstructive Sleep Apnea","volume":"16","author":"Yu","year":"2020","journal-title":"J. Clin. Sleep Med."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1186\/s41606-018-0022-2","article-title":"Impact of Blue-Depleted White Light on Pupil Dynamics, Melatonin Suppression and Subjective Alertness Following Real-World Light Exposure","volume":"2","author":"Zeitzer","year":"2018","journal-title":"Sleep Sci. Pract."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"420","DOI":"10.1111\/pcn.12073","article-title":"Development and Validation of the Japanese Version of the Athens Insomnia Scale","volume":"67","author":"Okajima","year":"2013","journal-title":"Psychiatry Clin. Neurosci."},{"key":"ref_29","first-page":"952","article-title":"The Patient Health Questionnaire, Japanese Version: Validity According to the Mini-International Neuropsychiatric Interview-Plus","volume":"101","author":"Muramatsu","year":"2007","journal-title":"Psychol. Rep."},{"key":"ref_30","doi-asserted-by":"crossref","unstructured":"Ubara, A., Sumi, Y., Ito, K., Matsuda, A., Matsuo, M., Miyamoto, T., and Kadotani, H. (2020). Self-Isolation Due to COVID-19 Is Linked to Small One-Year Changes in Depression, Sleepiness, and Insomnia: Results from a Clinic for Sleep Disorders in Shiga Prefecture, Japan. Int. J. Environ. Res. Public Health, 17.","DOI":"10.3390\/ijerph17238971"},{"key":"ref_31","doi-asserted-by":"crossref","unstructured":"Omichi, C., Kadotani, H., Sumi, Y., Ubara, A., Nishikawa, K., Matsuda, A., and Ozeki, Y. (2022). The NinJaSleep Study Group Prolonged Sleep Latency and Reduced REM Latency Are Associated with Depressive Symptoms in a Japanese Working Population. Int. J. Environ. Res. Public Health, 19.","DOI":"10.3390\/ijerph19042112"},{"key":"ref_32","unstructured":"Berry, R.B., Brooks, R., Gamaldo, C.E., Harding, S.M., Lloyd, R.M., Marcus, C.L., and Vaughn BV for the American Academy of Sleep Medicine (2016). The AASM Manual for the Scoring of Sleep and Associated Events: Rules, Terminology and Technical Specifications, American Academy of Sleep Medicine. Version 2.3."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"79","DOI":"10.1111\/coa.12341","article-title":"An Evidence-Based Approach to the Management of Snoring in Adults","volume":"40","author":"Berry","year":"2015","journal-title":"Clin. Otolaryngol."},{"key":"ref_34","first-page":"434","article-title":"Study of Snoring, Fourth report","volume":"64","author":"Ikematsu","year":"1961","journal-title":"J. Oto-Rhino-Laryngol. Soc. Jpn."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"461","DOI":"10.1093\/sleep\/30.4.461","article-title":"Redefining Success in Airway Surgery for Obstructive Sleep Apnea: A Meta Analysis and Synthesis of the Evidence","volume":"30","author":"Elshaug","year":"2007","journal-title":"Sleep"},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"450","DOI":"10.1097\/00005537-200403000-00012","article-title":"Incidence of Serious Complications After Uvulopalatopharyngoplasty","volume":"114","author":"Kezirian","year":"2004","journal-title":"Laryngoscope"},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"355","DOI":"10.1164\/rccm.201102-0316OC","article-title":"Continuous Positive Airway Pressure Reduces Postprandial Lipidemia in Obstructive Sleep Apnea: A Randomized, Placebo-Controlled Crossover Trial","volume":"184","author":"Phillips","year":"2011","journal-title":"Am. J. Respir. Crit. Care Med."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"270","DOI":"10.1016\/j.jad.2008.01.009","article-title":"Prevalence and Association of Somatic Symptoms in Patients with Major Depressive Disorder","volume":"110","author":"Vaccarino","year":"2008","journal-title":"J. Affect. Disord."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"1237","DOI":"10.1001\/jamaneurol.2017.2180","article-title":"Association of Sleep-Disordered Breathing with Cognitive Function and Risk of Cognitive Impairment: A Systematic Review and Meta-Analysis","volume":"74","author":"Leng","year":"2017","journal-title":"JAMA Neurol."}],"container-title":["International Journal of Environmental Research and Public Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1660-4601\/19\/9\/5007\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T22:57:35Z","timestamp":1760137055000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1660-4601\/19\/9\/5007"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,4,20]]},"references-count":39,"journal-issue":{"issue":"9","published-online":{"date-parts":[[2022,5]]}},"alternative-id":["ijerph19095007"],"URL":"https:\/\/doi.org\/10.3390\/ijerph19095007","relation":{},"ISSN":["1660-4601"],"issn-type":[{"value":"1660-4601","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,4,20]]}}}