Sleep Apnea Worsens Psychiatric Symptoms



SAN FRANCISCO – A simple questionnaire can pick up obstructive sleep apnea in psychiatric patients, according to a small study.

Screening is rare in psychiatric patients at present, but it’s important to diagnose obstructive sleep apnea (OSA) because it can make mental illness worse, contributing to depression and possibly to the risk of manic episodes. Symptoms can mimic mental illness as well, making patients irritable and tired, and OSA makes the use of benzodiazepines and other respiratory depressants problematic, said lead investigator Dr. Vanita Jain, a psychiatry department resident at the University of Utah, Salt Lake City.

"Sleep problems are so integral to psychiatric problems, [and] we wanted to make sure that along with psychiatric disorders, we were treating obstructive sleep apnea, too," she said.

The researchers screened 85 adult community hospital psychiatric inpatients with the STOP-Bang questionnaire, which is typically used as a presurgery screen and takes less than 2 minutes to fill out.

"Sleep problems are so integral to psychiatric problems."

The name refers to the survey’s eight yes/no questions: Do you snore loudly?, Do you often feel tired, fatigued, or sleepy during daytime?, Has anyone observed you stop breathing during your sleep?, Do you have or are you being treated for high blood pressure?, Body mass index more than 35 kg/m2?, Age over 50 years old?, Neck circumference greater than 40 cm?, and Gender male?

Most of the 85 subjects were white, and more than half were men. In all, 46 of the subjects answered yes to at least three of the questions, which is considered a positive screen.

Those patients had overnight pulse oximetry monitoring; 26 desaturated more than 10 times per hour. Fifteen of the 26 – most of the rest had been discharged or refused additional testing – underwent a polysomnography sleep study. Fourteen were ultimately diagnosed with OSA; three had more than 30 apneic episodes per hour.

They would have gone undiagnosed were it not for the questionnaire, Dr. Jain said.

Psychiatric patients can complicate OSA work-up. In the current study, for example, when patients were not coherent enough for an overnight stay in the sleep lab or if they were an escape risk, polysomnography was conducted in their rooms. If patients were "very psychotic or agitated, we just let it be" and asked them to return for an outpatient sleep study, Dr. Jain said.

Treatment options include continuous positive airway pressure (CPAP), special pillows to encourage side or elevated sleeping, dental prostheses to keep the jaw forward during sleep, weight loss, and surgery.

Dr. Jain said she has no disclosures.

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