Hostname: page-component-cd9895bd7-lnqnp Total loading time: 0 Render date: 2024-12-23T13:58:06.789Z Has data issue: false hasContentIssue false
  • English
  • Français

Obstructive sleep apnoea and schizophrenia: a primer for psychiatrists

Published online by Cambridge University Press:  24 June 2014

Abdulkader Alam  and
Kadiamada Nanaiah Roy Chengappa
Abdulkader Alam*
Affiliation:
Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
Kadiamada Nanaiah Roy Chengappa
Affiliation:
Comprehensive Recovery Services, Western Psychiatric Institute and Clinic, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
*
Abdulkader Alam, MD, Department of Psychiatry, University of Pittsburgh School of Medicine, 3811 O'Hara Street, Pittsburgh, PA 15213, USA. Tel: +14123831371; Fax: +14123833177; E-mail: [email protected]
Get access Rights & Permissions [Opens in a new window]

Extract

Alam A, Chengappa KNR. Obstructive sleep apnoea and schizophrenia: a primer for psychiatrists

Objective: The main objective of this review is to improve psychiatric clinician awareness of obstructive sleep apnoea (OSA) and its potential consequences in patients with schizophrenia. This article will also discuss the diagnosis and treatment options for OSA while considering the significant role psychiatrists can play in facilitating the diagnosis and treatment of OSA.

Data sources: Ovid, Medline and PsychInfo databases were searched for articles between 1960 and 2010. Search terms used were Sleep apnoea or apnoea and schizophrenia or psychosis. The number of articles retrieved was 38. Articles were carefully reviewed for any data pertinent to OSA in patients with schizophrenia.

Conclusions: OSA is a common disorder that is frequently unrecognised. As a chronic breathing condition, OSA is associated with adverse health outcomes and high mortality. OSA may co-occur with schizophrenia or evolve over time, especially with weight gain. The diagnosis should be considered whenever a patient presents with risk factors or clinical manifestations that are highly suggestive of OSA. Those who report snoring, daytime sleepiness and are obese or have a large neck circumference should be considered for an OSA diagnosis. Appropriate diagnosis and treatment of OSA can reduce daytime sleepiness, improve cardiovascular and other medical conditions, as well as reduce mortality. Psychiatrists can play very important role in suspecting OSA in their patients and making the initial referral. Furthermore, behavioural management, especially promoting weight loss and smoking cessation, are effective components of OSA treatment that psychiatrists are positioned to facilitate with their patients.

Keywords

excessive daytime sleepinessmortalitypsychosisschizophreniaobstructivesleep apnoea
Type
Review Article
Information
Acta Neuropsychiatrica , Volume 23 , Issue 5 , October 2011 , pp. 201 - 209
Copyright
Copyright © Cambridge University Press 2011

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1. Peppard, PE, Young, T, Palta, M, Skatrud, J. Prospective study of the association between sleep-disordered breathing and hypertension. N Engl J Med 2000;342:1378–1384. CrossRefGoogle ScholarPubMed
2. Peker, Y, Carlson, J, Hedner, J. Increased incidence of coronary artery disease in sleep apnoea: a long-term follow-up. Eur Respir J 2006;28:596–602. CrossRefGoogle ScholarPubMed
3. Punjabi, NM, Polotsky, VY. Disorders of glucose metabolism in sleep apnea. J Appl Physiol 2005;99:1998–2007. CrossRefGoogle ScholarPubMed
4. Punjabi, NM, Caffo, BS, Goodwin, JL Sleep-disordered breathing and mortality: a prospective cohort study. PLoS Med 2009;6:e1000132. CrossRefGoogle ScholarPubMed
5. Gurubhagavatula, I, Maislin, G, Nkwuo, JE, Pack, AI. Occupational screening for obstructive sleep apnea in commercial drivers. Am J Respir Crit Care Med 2004;170: 371–376. CrossRefGoogle ScholarPubMed
6. Sassani, A, Findley, LJ, Kryger, M, Goldlust, E, George, C, Davidson, TM. Reducing motor-vehicle collisions, costs, and fatalities by treating obstructive sleep apnea syndrome. Sleep 2004;27:453–458. CrossRefGoogle ScholarPubMed
7. George, CF. Sleep apnea, alertness, and motor vehicle crashes. Am J Respir Crit Care Med 2007;176:954–956. CrossRefGoogle ScholarPubMed
8. Sleep-related breathing disorders in adults: recommendations for syndrome definition and measurement techniques in clinical research. The Report of an American Academy of Sleep Medicine Task Force. Sleep 1999;22:667–689. CrossRefGoogle Scholar
9. Ancoli-Israel, S, Martin, J, Jones, DW et al. Sleep-disordered breathing and periodic limb movements in sleep in older patients with schizophrenia. Biol Psychiatry 1999; 45:1426–1432. CrossRefGoogle ScholarPubMed
10. Winkelman, JW. Schizophrenia, obesity, and obstructive sleep apnea. J Clin Psychiatry 2001;62:8–11. CrossRefGoogle ScholarPubMed
11. Punjabi, NM. The epidemiology of adult obstructive sleep apnea. Proc Am Thorac Soc 2008;5:136–143. CrossRefGoogle ScholarPubMed
12. Young, T, Palta, M, Dempsey, J, Skatrud, S, Weber, S, Badr, S. The occurrence of sleep-disordered breathing among middle-aged adults. N Engl J Med 1993;328: 1230–1235. CrossRefGoogle ScholarPubMed
13. Young, T, Evans, L, Finn, L, Palta, M. Estimation of the clinically diagnosed proportion of sleep apnea syndrome in middle-aged men and women. Sleep 1997;20:705–706. CrossRefGoogle ScholarPubMed
14. Kapur, V, Strohl, KP, Redline, S, Iber, C, O'Connor, G, Nieto, J. Under diagnosis of sleep apnea syndrome in US communities. Sleep Breath 2002;6:49–54. CrossRefGoogle Scholar
15. Young, T, Peppard, PE, Gottlieb, DJ. Epidemiology of OSA :a population health perspective. Am J Respir Crit Care Med 2002;165:1217–1239. CrossRefGoogle Scholar
16. Schroder, CM, O'Hara, R. Depression and obstructive sleep apnea (OSA). Ann Gen Psychiatry 2005;4:13. CrossRefGoogle ScholarPubMed
17. Baran, AS, Richert, AC. Obstructive sleep apnea and depression. CNS Spectr 2003;8:128–134. CrossRefGoogle ScholarPubMed
18. Takahashi, KI, Shimizu, T, Saito, Y, Sugita, T, Takahashi, Y, Hishikawa, Y. Prevalence of sleep-related respiratory disorders in 101 schizophrenic inpatients. Psychiatry Clin Neurosci 1998;52:229–231. CrossRefGoogle ScholarPubMed
19. Sharafkhaneh, A, Giray, N, Richardson, P, Young, T, Hirshkowitz, M. Association of psychiatric disorders and sleep apnea in a large cohort. Sleep 2005;28:1405–1411. CrossRefGoogle ScholarPubMed
20. Stanton, JM. Weight gain associated with neuroleptic medication: a review. Schizophr Bull 1995;21:463–472. CrossRefGoogle ScholarPubMed
21. Wirshing, DA, Pierre, JM, Wirshing, WC. Sleep apnea associated with antipsychotic-induced obesity. J Clin Psychiatry 2002;63:369–370. CrossRefGoogle ScholarPubMed
22. Rishi, MA, Shetty, M, Wolff, A, Amoateng-Adjepong, Y, Manthous, CA. Atypical antipsychotic medications are independently associated with severe obstructive sleep apnea. Clin Neuropharmacol 2010;33:109–113. CrossRefGoogle ScholarPubMed
23. Strohl, KP, Redline, S. Recognition of obstructive sleep apnea. Am J Respir Crit Care Med 1996;154:279–289. CrossRefGoogle ScholarPubMed
24. Levinson, PD, McGarvey, ST, Carlisle, CC, Eveloff, SE, Herbert, PN, Millman, RP. Adiposity and cardiovascular risk factors in men with obstructive sleep apnea. Chest 1993;103:1336–1342. CrossRefGoogle ScholarPubMed
25. Phillips, B, Cook, Y, Schmitt, F et al. Sleep apnea: prevalence of risk factors in the general population. South Med J 1989;82:1090–1092. CrossRefGoogle Scholar
26. Vgontzas, AN, Tan, TL, Bixler, EO, Martin, LF, Shubert, D, Kales, A. Sleep apnea and sleep disruption in obese patients. Arch Intern Med 1994;154:1705–1711. CrossRefGoogle ScholarPubMed
27. Peppard, PE, Young, T, Palta, M, Dempsey, J, Skatrud, J. Longitudinal study of moderate weight change and sleep-disordered breathing. JAMA 2000;284:3015–3021. CrossRefGoogle ScholarPubMed
28. Stradling, J, Crosby, J. Predictors and prevalence of obstructive sleep apnoea and snoring in 1001 middle aged men. Thorax 1991;46:85–90. CrossRefGoogle ScholarPubMed
29. Carmelli, D, Swan, GE, Bliwise, DL. Relationship of 30-year changes in obesity to sleep-disordered breathing in the Western Collaborative Group Study. Obes Res 2000;8: 632–637. CrossRefGoogle ScholarPubMed
30. Epstein, LJ, Kristo, D, Strollo, PJ et al. Clinical guideline for the evaluation, management and long-term care of obstructive sleep apnea in adults. J Clin Sleep Med 2009; 5:263–276. Google ScholarPubMed
31. Cistulli, PA. Craniofacial abnormalities in obstructive sleep apnoea: implications for treatment. Respirology 1996; 1:167–174. CrossRefGoogle ScholarPubMed
32. Young, T, Skatrud, J, Peppard, PE. Risk factors for obstructive sleep apnea in adults. JAMA 2004;291: 2013–2016. CrossRefGoogle ScholarPubMed
33. Jennum, P, Riha, RL. Epidemiology of sleep apnoea/ hypopnoea syndrome and sleep-disordered breathing. Eur Respir J 2009;33:907–914. CrossRefGoogle ScholarPubMed
34. Jennum, P, Sjol, A. Epidemiology of snoring and obstructive sleep apnoea in a Danish population. Age 1992;1: 30–60. Google Scholar
35. Wetter, DW, Young, TB, Bidwell, TR, Badr, MS, Palta, M. Smoking as a risk factor for sleep-disordered breathing. Arch Intern Med 1994;154:2219–2224. CrossRefGoogle ScholarPubMed
36. Khoo, SM, Tan, WC, Ng, TP, Ho, CH. Risk factors associated with habitual snoring and sleep-disordered breathing in a multi-ethnic Asian population: a population-based study. Respir Med 2004;98:557–566. CrossRefGoogle Scholar
37. Franklin, KA, Gislason, T, Omenaas, E et al. The influence of active and passive smoking on habitual snoring. Am J Respir Crit Care Med 2004;170:799–803. CrossRefGoogle ScholarPubMed
38. Taasan, VC, Block, AJ, Boysen, PG, Wynne, JW. Alcohol increases sleep apnea and oxygen desaturation in asymptomatic men. Am J Med 1981;71:240–245. Google ScholarPubMed
39. Block, AJ, Hellard, DW. Ingestion of either scotch or vodka induces equal effects on sleep and breathing of asymptomatic subjects. Arch Intern Med 1987;147: 1145–1147. CrossRefGoogle ScholarPubMed
40. Mitler, MM, Dawson, A, Henriksen, SJ, Sobers, M, Bloom, FE. Bedtime ethanol increases resistance of upper airways and produces sleep apneas in asymptomatic snorers. Alcohol Clin Exp Res 1988;12:801–805. CrossRefGoogle ScholarPubMed
41. Issa, FG, Sullivan, CE. Alcohol, snoring and sleep apnea. J Neurol Neurosurg Psychiatry 1982;45:353–359. CrossRefGoogle ScholarPubMed
42. Sigurdson, K, Ayas, NT. The public health and safety consequences of sleep disorders. Can J Physiol Pharmacol 2007;85:179–183. CrossRefGoogle ScholarPubMed
43. Fontaine, KR, Heo, M, Harrigan, EP et al. Estimating the consequences of antipsychotic induced weight gain on health and mortality rate. Psychiatry Res 2001;101:277–288. CrossRefGoogle ScholarPubMed
44. De Leon, J, Dadvand, M, Canuso, C, White, AO, Stanilla, JK, Simpson, GM. Schizophrenia and smoking: an epidemiological survey in a state hospital. Am J Psychiatry 1995;152:453–455. Google ScholarPubMed
45. Bushe, C, Holt, R. Prevalence of diabetes and impaired glucose tolerance in patients with schizophrenia. Br J Psychiatry 2004;184:s67–s71. CrossRefGoogle Scholar
46. Kilmer, G, Roberts, H, Hughes, E et al. Surveillance of certain health behaviors and conditions among states and selected local areas - behavioral risk factor surveillance system (BRFSS), United States, 2006. MMWR 2008;57: 1–188. Google Scholar
47. Marshall, NS, Wong, KK, Liu, PY, Cullen, SR, Knuiman, MW. Grunstein. Sleep apnea as an independent risk factor for all-cause mortality: the Busselton Health Study. Sleep 2008;31:1079–1085. Google ScholarPubMed
48. Somers, VK, White, DP, Amin, R et al. Sleep apnea and cardiovascular disease: an American Heart Association/ American College Of Cardiology Foundation Scientific Statement from the American Heart Association Council for High Blood Pressure Research Professional Education Committee, Council on Clinical Cardiology, Stroke Council, and Council On Cardiovascular Nursing. In collaboration with the National Heart, Lung, and Blood Institute National Center on Sleep Disorders Research (National Institutes of Health). JACC 2008;52:686–717. CrossRefGoogle Scholar
49. Simantirakis, EN, Schiza, SI, Marketou, ME et al. Severe bradyarrhythmias in patients with sleep apnoea: the effect of continuous positive airway pressure treatment: a long-term evaluation using an insertable loop recorder. Eur Heart J 2004;25:1070–1076. CrossRefGoogle ScholarPubMed
50. Tilkian, AG, Guilleminault, C, Schroeder, JS, Lehrman, KL, Simmons, FB, Dement, WC. Sleep-induced apnea syndrome. Prevalence of cardiac arrhythmias and their reversal after tracheostomy. Am J Med 1977;63:348–358. CrossRefGoogle ScholarPubMed
51. Miller, W. Cardiac arrhythmias and conduction disturbances in the sleep apnea syndrome. Prevalence and significance. Am J Med 1982;73:317–321. CrossRefGoogle Scholar
52. Fung, JW, Li, TS, Choy, DK et al. Severe obstructive sleep apnea is associated with left ventricular diastolic dysfunction. Chest 2002;121:422–429. CrossRefGoogle ScholarPubMed
53. Coughlin, SR, Mawdsley, L, Mugarza, JA, Calverley, PM, Wilding, JP. Obstructive sleep apnea is independently associated with an increased prevalence of metabolic syndrome. Eur Heart J 2004;25:735–741. CrossRefGoogle ScholarPubMed
54. Punjabi, NM, Sorkin, JD, Katzel, LI, Goldberg, AP, Schwartz, AR, Smith, PL. Sleep-disordered breathing and insulin resistance in middle-aged and overweight men. Am J Respir Crit Care Med 2002;165:677–682. CrossRefGoogle ScholarPubMed
55. Spiegel, K, Leproult, R, Van Cauter, E. Impact of sleep debt on metabolic and endocrine function. Lancet 1999; 354:1435–1439. CrossRefGoogle ScholarPubMed
56. Shaw, JE, Punjabi, NM, Wilding, JP, Alberti, KG, Zimmet, PZ. Sleep-disordered breathing and type 2 diabetes. A report from the International Diabetes Federation Taskforce on Epidemiology and Prevention. Diabetes Res Clin Pract 2008;81:2–12. CrossRefGoogle ScholarPubMed
57. Newcomer, JW. Metabolic considerations in the use of antipsychotic medications: a review of recent evidence. J Clin Psychiatry 2007;68(Suppl. 1):20–27. Google ScholarPubMed
58. Hennekens, CH, Hennekens, AR, Hollar, D, Casey, D. Schizophrenia and increased risks of cardiovascular disease. Am Heart J 2005;150:1115–1121. CrossRefGoogle ScholarPubMed
59. Muir-Cochrane, E. Medical co-morbidity risk factors and barriers to care for people with schizophrenia. J Psychiatr Ment Health Nurs 2006;13:447–452. CrossRefGoogle ScholarPubMed
60. Fleischman, JK, Ananthamoorthy, R, Greenberg, H, Harvey, C, Merlino, J. An unexplained death in the psychiatric emergency room: a case of undiagnosed obstructive sleep apnea?. Gen Hosp Psychiatry 2008;30:83–86. CrossRefGoogle ScholarPubMed
61. Pompeo, A, Salutari, P. Sudden death by sleep apnea syndrome associated with myxedema. A case report and a review of the literature. Minerva Endocrinol 1999;24: 37–44. Google Scholar
62. Collop, NA, Anderson, WM, Boehlecke, B et al. Clinical guidelines for the use of unattended portable monitors in the diagnosis of obstructive sleep apnea in adult patients. Portable Monitoring Task Force of the American Academy of Sleep Medicine. Clin Sleep Med 2007;3:737–747. Google ScholarPubMed
63. Johns, MW. A new method for measuring daytime sleepiness: The Epworth Sleepiness Scale. Sleep 1991;14: 540–545. CrossRefGoogle ScholarPubMed
64. Browman, CP, Sampson, MG, Yolles, SF et al. Obstructive sleep apnea and body weight. Chest 1984;85:435–438. CrossRefGoogle ScholarPubMed
65. Smith, PL, Gold, AR, Meyers, DA et al. Weight loss in mildly to moderately obese patients with obstructive sleep apnea. Ann Intern Med 1985;103:850–855. CrossRefGoogle ScholarPubMed
66. Kushida, CA, Littner, MR, Morgenthaler, T et al. Practice parameters for the indications for polysomnography and related procedures: an update for 2005. Sleep 2005; 28:499–521. CrossRefGoogle ScholarPubMed
67. Morgenthaler, TI, Kapen, S, Lee-Chiong, T et al. Practice parameters for the medical therapy of obstructive sleep apnea. Sleep 2006;29:1031–1055. Google ScholarPubMed
68. Sullivan, CE, Berthon-Jones, M, Issa, FG, Eves, L. Reversal of obstructive sleep apnea by continuous positive airway pressure applied through the nares. Lancet 1981;317: 862–865. CrossRefGoogle Scholar
69. Gay, P, Weaver, T, Loube, D, Iber, C. Evaluation of positive airway pressure treatment for sleep related breathing disorders in adults. Sleep 2006;29:381–401. CrossRefGoogle ScholarPubMed
70. Phillips, B, Kryger, MH. Management of obstructive sleep apnea-hypopnea syndrome: overview. In: Kryger, MH, Roth, T, Dement, WC, eds. Principles and practice of sleep medicine. 4th edn. Philadelphia: Saunders, 2005.Google Scholar
71. Giles, TL, Lasserson, TJ, Smith, B, White, J, Wright, JJ, Cates, CJ. Continuous positive airways pressure for obstructive sleep apnoea in adults. Cochrane Database Syst Rev 2006;3:CD001106. Google Scholar
72. He, J, Kryger, MH, Zorick, FJ, Conway, W, Roth, T. Mortality and apnea index in obstructive sleep apnea: Experience in 385 males patients. Chest 1988;94:9–14. CrossRefGoogle Scholar
73. Kushida, CA, Chediak, A, Berry, RB et al. Positive Airway Pressure Titration Task Force; American Academy of Sleep Medicine. Clinical guidelines for the manual titration of positive airway pressure in patients with obstructive sleep apnea. J Clin Sleep Med 2008;4:157–171. Google ScholarPubMed
74. Ferguson, KA, Cartwright, R, Rogers, R, Schmidt-Nowara, W. Oral appliances for snoring and obstructive sleep apnea: a review. Sleep 2006;29:244–262. CrossRefGoogle ScholarPubMed
75. Maurer, JT. Surgical treatment of obstructive sleep apnea: standard and emerging techniques. Curr Opin Pulm Med 2010;16:552–558. CrossRefGoogle ScholarPubMed
76. SAGES Guidelines Committee. Guidelines for clinical application of laparoscopic bariatric surgery: Society of American Gastrointestinal and Endoscopic Surgeons. 2009; 5:387–405. Google Scholar
77. Karanti, A, Landen, M. Treatment refractory psychosis remitted upon treatment with continuous positive airway pressure: a case report. Psychopharmacol Bull 2007;40: 113–117. Google ScholarPubMed
78. Boufidis, S, Kosmidis, MH, Bozikas, VP, Daskalopoulou-Vlahoyianni, E, Pitsavas, S, Karavatos, A. Treatment outcome of obstructive sleep apnea syndrome in a patient with schizophrenia: case report. Int J Psychiatry Med 2003; 33:305–310. CrossRefGoogle Scholar
79. Dennis, JL, Crisham, KP. Chronic assaultive behavior improved with sleep apnea treatment. J Clin Psychiatry 2001;62:571–572. CrossRefGoogle ScholarPubMed
80. Berrettini, WH. Paranoid psychosis and sleep apnea syndrome. Am J Psychiatry 1980;137:493–494. Google ScholarPubMed
81. Martin, PR, Lefebvre, AM. Surgical treatment of sleep-apnea-associated psychosis. Can Med Assoc J 1981;124: 978–980. Google ScholarPubMed
82. Chiner, E, Arriero, JM, Signes-Costa, J, Marco, J. Acute psychosis after CPAP treatment in a schizophrenic patient with sleep apnoea-hypopnoea syndrome. Eur Respir J 2001; 17:313–315. CrossRefGoogle Scholar
83. Ramos Platon, MJ, Espinar Sierra, J. Changes in psychopathological symptoms in sleep apnea patients after treatment with nasal continuous positive airway pressure. Int J Neurosci 1992;62:173–195. CrossRefGoogle ScholarPubMed
84. Brown, S, Inskip, H, Barraclough, B. Causes of the excess mortality of schizophrenia. Br J Psychiatry 2000;177: 212–217. CrossRefGoogle ScholarPubMed