Why Screen for Obstructive Sleep Apnea?

September 9, 2013

In my last blog entry, I mentioned the importance of paying attention to sleep disorders in psychiatric patients. One of the most common and most important of these is sleep apnea. 

In sleep apnea, breathing is shallow and slow, sometimes resulting in shallow breaths called hypopneas, or in pauses, called apneas, that last from seconds to over a minute. Sleep apnea is frequently accompanied by snoring, which is typically recognized by others (bed partners, family members, etc.) long before patients notice it themselves. 

Roughly 7% to 8% of Americans suffer from at least moderate sleep apnea. Sleep apnea is common in obese patients but can affect anyone. Women enjoy relatively lower risks of sleep apnea until they reach menopause, when their risk increases to match (if not exceed) that seen in men. 

In addition to loud snoring, signs and symptoms may also include excessive daytime somnolence, fatigue, concentration impairment, memory problems, weight gain, chronic pain, and other symptoms. Obstructive sleep apnea increases the risk of hypertension, diabetes, stroke, pulmonary hypertension, heart attack, and death. 

Patients with sleep apnea appear to be at significantly increased risk of depression. A study published earlier this year demonstrated that over a one-year period, patients diagnosed with obstructive sleep apnea were 2.18 times more likely to develop major depression than those without obstructive sleep apnea  [1].  Another study demonstrated that patients reporting depression were 5.86 times more likely to report a diagnosis of obstructive sleep apnea than control patients [2]. 

There is also evidence that sleep apnea is over-represented in patients with treatment refractory depression, with perhaps more than 20% of such patients suffering from sleep apnea. 

Consider screening for obstructive sleep apnea in patients with mood disorders, especially those patients who fail to respond to multiple treatment interventions. 

Do you routinely screen your patients for obstructive sleep apnea? 

References

1.Chen YH, Keller JK, Kang JH, et al. Obstructive sleep apnea and the subsequent risk of depressive disorder: a population-based follow-up study.

J Clin Sleep Med. 2013;9(5):417-423.

2. Cheng P, D Casement M, Chen CF, et al. Sleep-disordered breathing in major depressive disorder. J Sleep Res. 2013;22(4):459-462.

Chris Bojrab, MD, is the president of Indiana Health Group, the largest multidisciplinary behavioral health private practice in Indiana, established in 1987. He is a board certified psychiatrist and a Distinguished Fellow of the American Psychiatric Association who treats child, adolescent, adult, and geriatric patients. His areas of interest include psychopharmacology, sleep disorders, and gambling addiction. For more information and disclosures, visit www.chrisbojrabmd.com

The views expressed on this blog are solely those of the blog post author and do not necessarily reflect the views of Psych Congress Network or other Psych Congress Network authors.  

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