Clinical Characteristics of Obstructive Sleep Apnea in Psychiatric Disease

Abstract

Patients with serious psychiatric diseases (major depressive disorder (MDD), bipolar disorder (BD), and schizophrenia and psychotic disorder) often complain about sleepiness during the day, fatigue, low energy, concentration problems, and insomnia; unfortunately, many of these symptoms are also frequent in patients with Obstructive Sleep Apnea (OSA). However, existing data about the clinical appearance of OSA in Psychiatric Disease are generally missing. The aim of our study was a detailed and focused evaluation of OSA in Psychiatric Disease, in terms of symptoms, comorbidities, clinical characteristics, daytime respiratory function, and overnight polysomnography data. We examined 110 patients (56 males and 54 females) with stable Psychiatric Disease (Group A: 66 with MDD, Group B: 34 with BD, and Group C: 10 with schizophrenia). At baseline, each patient answered the STOP–Bang Questionnaire, Epworth Sleepiness Scale (ESS), Fatigue Severity Scale (FSS), and Hospital Anxiety and Depression Scale (HADS) and underwent clinical examination, oximetry, spirometry, and overnight polysomnography. Body Mass Index (BMI), neck, waist, and hip circumferences, and arterial blood pressure values were also measured. The mean age of the whole population was 55.1 ± 10.6 years. The three groups had no statistically significant difference in age, BMI, hip circumference, and systolic and diastolic arterial blood pressure. Class II and III obesity with BMI > 35 kg/m2 was observed in 36 subjects (32.14%). A moderate main effect of psychiatric disease was observed in neck (p = 0.044, η2 = 0.064) and waist circumference (p = 0.021, η2 = 0.078), with the depression group showing the lowest values, and in pulmonary function (Forced Vital Capacity (FVC, %), p = 0.013, η2 = 0.084), with the psychotic group showing the lowest values. Intermediate to high risk of OSA was present in 87.37% of participants, according to the STOP–Bang Questionnaire (≥3 positive answers), and 70.87% responded positively for feeling tired or sleepy during the day. An Apnea–Hypopnea Index (AHI) ≥ 15 events per hour of sleep was recorded in 72.48% of our patients. AHI was associated positively with male sex, schizophrenia, neck, and waist circumferences, STOP–Bang and ESS scores, and negatively with respiratory function. A large main effect of psychiatric medications was observed in waist circumference (p = 0.046, η2 = 0.151), FVC (%) (p = 0.027, η2 = 0.165), and in time spend with SaO2 < 90% (p = 0.006, η2 = 0.211). Our study yielded that patients with Psychiatric Disease are at risk of OSA, especially men suffering from schizophrenia and psychotic disorders that complain about sleepiness and have central obesity and disturbed respiratory function. Screening for OSA is mandatory in this medical population, as psychiatric patients have significantly poorer physical health than the general population and the coexistence of the two diseases can further negatively impact several health outcomes.

Anxiety and Depression in Patients with Obstructive Sleep Apnoea before and after Continuous Positive Airway Pressure: The ADIPOSA Study

“…It has been well evidenced that depression, the most common affective disorder found in OSA [16][17][18], is also related to the occurrence and worsening of severe medical conditions such as metabolic and cardiovascular diseases [19], besides being a major contributing factor to non-compliance with OSA treatment [20]. According to a recent study on the prevalence of OSA in psychiatric disease [21], moderate to severe OSA can be found in 72.48% of patients with affective and psychotic disorders, so the consideration of mood disturbances should play an important role in both the evaluation and treatment of this condition. Recent epidemiological studies have also indicated that anxiety may be found in 53.9% of patients with OSA, associated with higher body mass index (BMI) and severity of OSA [11], and once again with poor compliance to OSA therapy [20].…”

Assessment and treatment of sleep problems in bipolar disorder—A guide for psychologists and clinically focused review

“…This condition is linked to increased risk of cardiovascular disorders (Lévy et al, ), metabolic syndrome (Vancampfort et al, ), and diabetes (Stubbs, Vancampfort, De Hert, & Mitchell, ) and thus elevated mortality in BD (Hayes, Miles, Walters, King, & Osborn, ). Obstructive sleep apnoea is diagnosed by overnight sleep assessment in a sleep laboratory, is treated by continuous positive airway pressure, and requires referral to a sleep medicine clinic (preferably one with experience in psychiatric populations; Bastiampillai, Khor, & Dhillon, ; Knechtle et al, ). Similarly, the treatment of DSPS (involving theoretically driven choices around timing of light and melatonin) requires circadian expertise (Sack et al, ) and potentially the involvement of a sleep medicine clinic.…”

Obstructive Sleep Apnea: Evaluation of high risk individuals, knowledge and associated factors among a representative sample of Lebanese adults

“…Insightful that sleep plays a role in intellectual and academic attainments 18,19 , OSA has been involved with impaired daytime function and psychiatric symptoms 20 . It has a an impact on road safety and contributes to the burden of road-related morbidity and mortality 21 .…”