Obstructive sleep apnea in severe mental disorders.

Abstract

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.

Higher Risk for Obstructive Sleep Apnea in Chronic Treatment-Resistant Depression

“…Based on the results, the risk for OSA in patients with cTRD is much greater than the general population of Kermanshah. The main finding is consistent with studies reporting an increased incidence of OSA symptoms in patients with depression, building a long-standing co-occurrence of mood and sleep disorders (11,24). The results are also consistent with studies indicating that untreated OSA patients might show higher depressive symptoms (38)(39)(40).…”

“…As mentioned, several studies have already investigated the association between MDD and coexisting OSA (18,(24)(25)(26)(27). However, a few studies have examined if coexisting OSA could lead to treatment-resistance in MDD or a bidirectional association could be anticipated (i.e.…”

Evaluation of the risk factors of depressive disorders comorbid with obstructive sleep apnea

“…Szaulińska et al10 reported that obstructive sleep apnea (OSA) is present in 11%–18% of patients with MDDs, 15%–48% of patients with schizophrenia, and 21%–43% of patients with bipolar disorder, but in only 5% of the general population 11. One study has shown that patients diagnosed with OSA are at an increased risk of a diagnosis of depression 12.…”

“…One study has shown that patients diagnosed with OSA are at an increased risk of a diagnosis of depression 12. Additionally, the symptoms of sleep apnea might imitate the symptoms of depression, including sleep disturbance, general fatigue, decreased volition and judgment ability, aggravated cognitive impairment, and a lower quality of life 10. In addition, OSA might exacerbate symptom severity in MDDs 8.…”

“…In depressive disorders, comorbid OSA is even higher 10. Physicians should consider screening for OSA when assessing patients for depression, as it may indicate more difficulty to treat depression 8,19.…”