AccScience Publishing / JCBP / Volume 2 / Issue 1 / DOI: 10.36922/jcbp.1040
Cite this article
Journal Browser
Volume | Year
News and Announcements
View All

Correlations between depressive disorder, obstructive sleep apnea, and hypothalamic inflammation

Guanzhong Dong1† Xuanyan Zhu1† Qiaoyang Zhang1 Yuwen Jiao2 Yi Ma3 Shumin Zhu1 Lihao Zhang1 Min Zhang4 Liming Tang2* Yin Cao1*
Show Less
1 Department of Psychology, The Affiliated Changzhou No. 2 People’s Hospital of Nanjing Medical University, Changzhou, 231000, China
2 Department of Gastrointestinal Surgery, The Affiliated Changzhou No. 2 People’s Hospital of Nanjing Medical University, Changzhou, 231000, China
3 Department of Radiology, The Affiliated Changzhou No. 2 People’s Hospital of Nanjing Medical University, Changzhou, 231000, China
4 Department of Neurology, The Affiliated Changzhou No. 2 People’s Hospital of Nanjing Medical University, Changzhou, 231000, China
Submitted: 4 June 2023 | Accepted: 12 September 2023 | Published: 26 October 2023
© 2023 by the Author(s). This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution 4.0 International License ( )

Obesity is a significant public health concern in China, with a 2.5-fold increase in prevalence over the past 30 years. This increase corresponds to a rise in the prevalence of obstructive sleep apnea (OSA). This study aims to investigate the associations of OSA with depressive disorders and hypothalamic inflammation in obese young men. Between January 2020 and December 2021, 62 obese male patients were selected and divided into two groups: a depressive disorder group (18 cases) and a non-depressive disorder group (44 cases) according to the diagnostic criteria of the DSM-5 combined with depressive disorder. All patients were monitored using a portable sleep monitor. Hypothalamic inflammation was evaluated using quantitative magnetic resonance imaging (MRI) by calculating the signal intensity (SI) ratio of the T2-weighted phase of the hypothalamus/amygdala (H/A). Differences were observed in the respiratory event index (REI), lowest oxygen saturation, and oxygen desaturation index (P < 0.05). In the depressive disorder group, the left H/A was significantly higher than in the non-depressive disorder group (P = 0.002), whereas the right H/A did not differ significantly between the two groups (P > 0.05). Furthermore, the left H/A exhibited correlations with REI and body mass index (BMI) (P < 0.05), while no correlation was found between the right H/A and AHI (P > 0.05). In conclusion, our findings suggest that the left hypothalamic inflammation is positively correlated with the severity of OSA, implying that left hypothalamic inflammation may represent a potential mechanism underlying OSA in obese young patients with depressive disorders.

Hypothalamus inflammation
Depressive disorders
Obstructive sleep apnea
Changzhou Key Laboratory of Gastroenterology
Changzhou Science and Technology Program
  1. Pan XF, Wang L, Pan A, 2021, Epidemiology and determinants of obesity in China. Lancet Diabetes Endocrinol, 9: 373–392.


  1. Matsumoto T, Chin K, 2019, Prevalence of sleep disturbances: Sleep disordered breathing, short sleep duration, and non-restorative sleep. Respir Investig, 57: 227–237.


  1. Benjafield AV, Ayas NT, Eastwood PR, et al., 2019, Estimation of the global prevalence and burden of obstructive sleep apnoea: A literature-based analysis. Lancet Respir Med, 7: 687–698.


  1. Peppard PE, Young T, Palta M, et al., 2000, Longitudinal study of moderate weight change and sleep-disordered breathing. J Am Med Assoc, 284: 3015–3021.


  1. Young T, Shahar E, Nieto FJ, et al., 2002, Predictors of sleep-disordered breathing in community-dwelling adults: The Sleep Heart Health Study. Arch Intern Med, 162: 893–900.


  1. Johansson K, Neovius M, Lagerros YT, et al., 2009, Effect of a very low energy diet on moderate and severe obstructive sleep apnoea in obese men: A randomised controlled trial. BMJ, 339: b4609.


  1. Rodrigues GD, Fiorelli EM, Furlan L, et al., 2021, Obesity and sleep disturbances: The “chicken or the egg” question. Eur J Intern Med, 92: 11–16.


  1. Hobzova M, Prasko J, Vanek J, et al., 2017, Depression and obstructive sleep apnea. Neuro Endocrinol Lett, 38: 343–352.


  1. Bjorvatn B, Rajakulendren N, Lehmann S, et al., 2018, Increased severity of obstructive sleep apnea is associated with less anxiety and depression. J Sleep Res, 27: e12647.


  1. Dong GZ, Yang HJ, Jiao YW, et al., 2021, Using quantitative imaging to determine the correlation between hypothalamic inflammation and anxiety and depression in young patients with obesity. Ann Palliat Med, 10: 8043–8050.


  1. Gupta MA, Simpson FC, 2015, Obstructive sleep apnea and psychiatric disorders: A systematic review. J Clin Sleep Med, 11: 165–175.


  1. Cho HJ, Eisenberger NI, Olmstead R, et al., 2016, Pre-existing mild sleep disturbance as a vulnerability factor for inflammation-induced depressed mood: A human experimental study. Transl Psychiatry, 6: e750.


  1. Irwin MR, 2019, Sleep and inflammation: Partners in sickness and in health. Nat Rev Immunol, 19: 702–715.


  1. Bonsignore MR, Saaresranta T, Riha RL, 2019, Sex differences in obstructive sleep apnoea. Eur Respir Rev, 28: 190030.


  1. Bonsignore MR, McNicholas WT, Montserrat JM, et al., 2012, Adipose tissue in obesity and obstructive sleep apnoea. Eur Respir J, 39: 746–767.


  1. Bahammam RA, Al-Qahtani KM, Aleissi SA, et al., 2020, The associations of gender, menopause, age, and asthma with REM-predominant obstructive sleep apnea: A prospective observational study. Nat Sci Sleep, 12: 721–735.


  1. Martins FO, Conde SV, 2021, Gender differences in the context of obstructive sleep apnea and metabolic diseases. Front Physiol, 12: 792633.


  1. Battle DE, 2013, Diagnostic and statistical manual of mental disorders (DSM). Codas, 25: 191–192. doi: 10.1590/s2317- 17822013000200017


  1. Cooksey JA, Balachandran JS, 2016, Portable monitoring for the diagnosis of OSA. Chest, 149: 1074–1081.


  1. Thaler JP, Yi CX, Schur EA, et al., 2012, Obesity is associated with hypothalamic injury in rodents and humans. J Clin Invest, 122: 153–162.


  1. Schur EA, Melhorn SJ, Oh SK, et al., 2015, Radiologic evidence that hypothalamic gliosis is associated with obesity and insulin resistance in humans. Obesity (Silver Spring), 23: 2142–2148.


  1. Kreutzer C, Peters S, Schulte DM, et al., 2017, Hypothalamic inflammation in human obesity is mediated by environmental and genetic factors. Diabetes, 66: 2407–2415.


  1. Rebelos E, Hirvonen J, Bucci M, et al., 2020, Brain free fatty acid uptake is elevated in morbid obesity, and is irreversible 6 months after bariatric surgery: A positron emission tomography study. Diabetes Obes Metab, 22: 1074–1082.


  1. Lee D, Thaler JP, Berkseth KE, et al., 2013, Longer T2 relaxation time is a marker of hypothalamic gliosis in mice with diet-induced obesity. Am J Physiol Endocrinol Metab, 304: E1245–E1250.


  1. Pearson NJ, Johnson LL, Nahin RL, 2006, Insomnia, trouble sleeping, and complementary and alternative medicine: Analysis of the 2002 national health interview survey data. Arch Intern Med, 166: 1775–1782.


  1. Vgontzas AN, Lin HM, Papaliaga M, et al., 2008, Short sleep duration and obesity: The role of emotional stress and sleep disturbances. Int J Obes (Lond), 32: 801–809.


  1. Stubbs B, Vancampfort D, Veronese N, et al., 2016, The prevalence and predictors of obstructive sleep apnea in major depressive disorder, bipolar disorder and schizophrenia: A systematic review and meta-analysis. J Affect Disord, 197: 259–267.


  1. Knechtle B, Economou NT, Nikolaidis PT, et al., 2019, Clinical characteristics of obstructive sleep apnea in psychiatric disease. J Clin Med, 8: 534.


  1. Cheng P, Casement MD, Chen C, et al., 2013, Breathing and depression sleep disordered breathing in major depressive disorder. J Sleep Res, 22: 459–462.


  1. Siyam M, Benhamou D, 2007, Prise en charge anesthésique d’un adulte atteint d’un syndrome d’apnées obstructives du sommeil (SAOS) Anaesthetic management of adult patients with obstructive sleep apnea syndrome. Ann Fr Anesth Reanim, 26: 39–52.


  1. Chen YH, Keller JK, Kang JH, et al., 2013, Obstructive sleep apnea and the subsequent risk of depressive disorder: A population-based follow-up study. J Clin Sleep Med, 9: 417–423.


  1. Senaratna CV, English DR, Currier D, et al., 2016, Sleep apnoea in Australian men: Disease burden, co-morbidities, and correlates from the Australian longitudinal study on male health. BMC Public Health, 16: 1029.


  1. Ejaz SM, Khawaja IS, Bhatia S, et al., 2011, Obstructive sleep apnea and depression: A review. Innov Clin Neurosci, 8: 17–25.


  1. Vanek J, Prasko J, Genzor S, et al., 2020, Obstructive sleep apnea, depression and cognitive impairment. Sleep Med, 72: 50–58.


  1. Ong JC, Gress JL, Pedro-Salcedo MG, et al., 2009, Frequency and predictors of obstructive sleep apnea among individuals with major depressive disorder and insomnia. J Psychosom Res, 67: 135–141.


  1. Phillips BA, Berry DT, Lipke-Molby TC, 1996, Sleep-disordered breathing in healthy, aged persons: Fifth and final year follow-up. Chest, 110: 654–658.


  1. Yang X, Yang J, Yang C, et al., 2020, Continuous positive airway pressure can improve depression in patients with obstructive sleep apnoea syndrome: A meta-analysis based on randomized controlled trials. J Int Med Res, 48: 300060519895096.


  1. Dokkedal-Silva V, Galduróz JCF, Tufik S, et al., 2018, Association of obesity, sleep apnea and hypothalamic inflammation: Novel possibilities of research. Eur J Intern Med, 52: e17–e18.


  1. Cai D, Khor S, 2019, Hypothalamic microinflammation paradigm in aging and metabolic diseases. Cell Metab, 30: 19–35.


  1. O’Rahilly S, Farooqi IS, Yeo GSH, et al., 2003, Minireview: Human obesity-lessons from monogenic disorders. Endocrinology, 144: 3757–3764.


  1. Kim JD, Yoon NA, Jin S, et al., 2019, Microglial UCP2 mediates inflammation and obesity induced by high-fat feeding. Cell Metab, 30: 952.e5–962.e5.


  1. Benomar Y, Taouis M, 2019, Molecular mechanisms underlying obesity-induced hypothalamic inflammation and insulin resistance: Pivotal role of resistin/TLR4 pathways. Front Endocrinol (Lausanne), 10: 140.


  1. Dong GZ, Zhang QY, Jiao YW, et al., 2022, The contribution of Type 2 diabetes mellitus to hypothalamic inflammation and depressive disorders in young patients with obesity. Ann Transl Med, 10: 134.


  1. Irwin MR, Wang M, Campomayor CO, et al., 2006, Sleep deprivation and activation of morning levels of cellular and genomic markers of inflammation. Arch Intern Med, 166: 1756–1762.


  1. Vgontzas AN, Pejovic S, Zoumakis E, et al., 2007, Hypothalamic-pituitary-adrenal axis activity in obese men with and without sleep apnea: Effects of continuous positive airway pressure therapy. J Clin Endocrinol Metab, 92: 4199–4207.


  1. Yalamanchali S, Farajian V, Hamilton C, et al., 2013, Diagnosis of obstructive sleep apnea by peripheral arterial tonometry: Meta-analysis. JAMA Otolaryngol Head Neck Surg, 139: 1343–1350.


  1. Masa JF, Duran-Cantolla J, Capote F, et al., 2014, Effectiveness of home single-channel nasal pressure for sleep apnea diagnosis. Sleep, 37: 1953–1961.
Conflict of interest
All authors certify that they have no affiliations with or involvement in any organization or entity with any financial or non-financial interests in the subject matter or materials discussed in this manuscript.
Back to top
Journal of Clinical and Basic Psychosomatics, Electronic ISSN: 2972-4414 Published by AccScience Publishing