The prevalence of obstructive sleep apnoea (OSA) is estimated to be 3-7.5% in men and 2-3% in women. In mentally ill population it is even higher, as these patients are a high risk OSA group. The aim of the paper was a review of literature about the prevalence of sleep apnoea in patients with schizophrenia, bipolar disorder and recurrent depressive disorder.The available data show that OSA is present in 15-48% of patients with schizophrenia, 21-43% of patients with bipolar disorder and 11-18% of patients with recurrent depressive disorder. The lack of diagnosis of OSA in people with mental illnesses has multiple negative consequences. The symptoms of sleep apnoea might imitate the symptoms of mental illnesses such as negative symptoms of schizophrenia and symptoms of depression, they might as well aggravate the cognitive impairment. A number of the drugs used in mental disorders may aggravate the symptoms of OSA. OSA is as well the risk factor for cardiovascular and metabolic diseases which are a serious clinical problem in mentally ill people and contribute to shortening of their expected lifespan. From the point of view of the physicians treating OSA it is important to pay attention to the fact that co-existing depression is the most common reason for resistant daytime sleepiness in OSA patients treated effectively with Continuous Positive Airway Pressure (CPAP). CPAP therapy leads to significant improvement of mood. However, in schizophrenia and bipolar patients it may rarely lead to acute worsening of mental state, exacerbation of psychotic symptoms or phase shift from depression to mania.

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Introduction Sleep apnea is a prevalent disorder but it is frequently overlooked in diagnosing mental disorders. The aim of the present study was to screen for sleep apnea in a group of patients referred for diagnosing mental disorders or non-restorative sleep and to assess the accuracy with which such testing can be replaced with commonly used screening questionnaires for sleep apnea. Methods 104 patients were investigated – 58 with mental disorders (26 with affective disorders, 26 with schizophrenia spectrum disorders, 3 with anxiety disorders, 3 with neurocognitive disorders; mean age 37.5±9.5 years, 24% females, BMI 32.8±6.5 kg/m2) and 46 with non-restorative sleep (mean age 41.2±14.6, 39% females, BMI 26.3±4.8 kg/m2). The patients were screened for sleep apnea with a home sleep apnea test (HSAT) based on peripheral arterial tonometry (PAT) and were asked to fill in the Sleep Apnea Scale from Sleep Disorders Questionnaire (SDQ-SA), the STOP-BANG and the Berlin questionnaires (BQ), and the Epworth Sleepiness Scale (ESS). Results Apnea-Hypopnea Index of > 5/h was found in 57 (55%) patients: 36 (62%) patients with mental disorders and 21 (45%) patients with non-restorative sleep. An increased risk for sleep apnea was found in 45 patients (43.3%) using SDQ-SA, 64 (61.5%) using BQ, 80 (76.9%) patients using STOP-BANG with the cut-off of 3 points and 30 (28.8%) with the cut-off of 5 points. Positive predictive values were: 65.9% for SDQ-SA, 71.0% for BQ, 68.8% for STOP-BANG with the cut-off of 3 point and 75.9% with the cut-off of 5 points. Negative predictive values were 49.1%, 63.0%, 83.3% and 51.4% respectively. Diagnostic accuracy was highest for STOP-BANG with the cut-off of 3 points – 72.3% and lowest for SDQ-SA – 56.6%. Excessive Daytime Sleepiness was found in 44 (42.3%) of patients. Three patients (2.9%) refused or did not complete the HSAT. Conclusion Inclusion of HSAT in the diagnostic process revealed high prevalence of sleep apnea in patients with mental disorders. Psychiatrists should be encouraged to include HSAT in evaluation of patients. Such testing is patient-friendly and using only screening questionnaires does not provide high enough diagnostic accuracy. Support (if any)

Purpose: Analysis of heart rate variability (HRV) based on ECG is a non-invasive method which assesses the activity of both the sympathetic and the parasympathetic part of autonomic nervous system. HRV measurement describes time differences between consecutive heartbeats-intervals between the R waves of the QRS complex. The aim of the article is to present results of research on HRV in selected mental disorders. Views: People with mental disorders have reduced HRV, especially components dependent on parasympathetic activity, and more often than healthy subjects develop cardiovascular diseases. Moreover, drugs psychiatric drugs can also have negative influence on HRV. Reduction of HRV, dependent on sympathetic predominance, has been described in numerous mental disorders-schizophrenia, affective and anxiety disorders, insomnia. Among the antipsychotics, the least favorable for heart is the effect of clozapine, treatment with amisulpride and risperidone seems safe. Antidepressants also have a different cardiological safety profile. The least beneficial is the action of tricyclic antidepressants. Venlafaxine and mirtazapine also lower HRV, while SSRIs, including paroxetine which has the largest in this group cholinolytic action, seem to be safe. In the case of HRV-reducing drugs it is advisable to use the lowest effective dose, as the HRV parameters are reduced with increasing the dose of the drug. Conclusions: HRV analysis is reliable and technically easy to perform. The results of presented studies indicate that HRV assessment may be widely used in psychiatry as a biological marker of an autonomic excitation and to evaluate cardiological safety of drugs.