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Liu H, Wang X, Feng H, Zhou S, Pan J, Ouyang C, Hu X. Obstructive sleep apnea and mental disorders: a bidirectional mendelian randomization study. BMC Psychiatry 2024; 24:304. [PMID: 38654235 DOI: 10.1186/s12888-024-05754-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Accepted: 04/09/2024] [Indexed: 04/25/2024] Open
Abstract
BACKGROUND Previous studies have reported associations between obstructive sleep apnea (OSA) and several mental disorders. However, further research is required to determine whether these associations are causal. Therefore, we evaluated the bidirectional causality between the genetic liability for OSA and nine mental disorders by using Mendelian randomization (MR). METHOD We performed two-sample bidirectional MR of genetic variants for OSA and nine mental disorders. Summary statistics on OSA and the nine mental disorders were extracted from the FinnGen study and the Psychiatric Genomics Consortium. The primary analytical approach for estimating causal effects was the inverse-variance weighted (IVW), with the weighted median and MR Egger as complementary methods. The MR Egger intercept test, Cochran's Q test, Rucker's Q test, and the MR pleiotropy residual sum and outlier (MR-PRESSO) test were used for sensitivity analyses. RESULT MR analyses showed that genetic liability for major depressive disorder (MDD) was associated with an increased risk of OSA (odds ratio [OR] per unit increase in the risk of MDD, 1.29; 95% CI, 1.11-1.49; P < 0.001). In addition, genetic liability for OSA may be associated with an increased risk of attention-deficit/hyperactivity disorder (ADHD) (OR = 1.26; 95% CI, 1.02-1.56; p = 0.032). There was no evidence that OSA is associated with other mental disorders. CONCLUSION Our study indicated that genetic liability for MDD is associated with an increased risk of OSA without a bidirectional relationship. Additionally, there was suggestive evidence that genetic liability for OSA may have a causal effect on ADHD. These findings have implications for prevention and intervention strategies targeting OSA and ADHD. Further research is needed to investigate the biological mechanisms underlying our findings and the relationship between OSA and other mental disorders.
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Affiliation(s)
- Heming Liu
- Department of Epidemiology and Health Statistics, School of Public Health, Lanzhou University, No.199, Donggang West Road, Chengguan District, 730000, Lanzhou, Gansu Province, China
| | - Xuemei Wang
- Department of Epidemiology and Health Statistics, School of Public Health, Lanzhou University, No.199, Donggang West Road, Chengguan District, 730000, Lanzhou, Gansu Province, China
| | - Hu Feng
- Department of Epidemiology and Health Statistics, School of Public Health, Lanzhou University, No.199, Donggang West Road, Chengguan District, 730000, Lanzhou, Gansu Province, China
| | - Shengze Zhou
- Department of Epidemiology and Health Statistics, School of Public Health, Lanzhou University, No.199, Donggang West Road, Chengguan District, 730000, Lanzhou, Gansu Province, China
| | - Jinhua Pan
- Department of Epidemiology and Health Statistics, School of Public Health, Lanzhou University, No.199, Donggang West Road, Chengguan District, 730000, Lanzhou, Gansu Province, China
| | - Changping Ouyang
- Department of Epidemiology and Health Statistics, School of Public Health, Lanzhou University, No.199, Donggang West Road, Chengguan District, 730000, Lanzhou, Gansu Province, China
| | - Xiaobin Hu
- Department of Epidemiology and Health Statistics, School of Public Health, Lanzhou University, No.199, Donggang West Road, Chengguan District, 730000, Lanzhou, Gansu Province, China.
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Conde SV, Polotsky VY, Joseph V, Kinkead R. On the origins of sleep disordered breathing, cardiorespiratory and metabolic dysfunction: which came first, the chicken or the egg? J Physiol 2023; 601:5509-5525. [PMID: 36988138 PMCID: PMC10539476 DOI: 10.1113/jp284113] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Accepted: 03/08/2023] [Indexed: 03/30/2023] Open
Abstract
Sleep disordered breathing (SDB) is a complex, sex specific and highly heterogeneous group of respiratory disorders. Nevertheless, sleep fragmentation and repeated fluctuations of arterial blood gases for several hours per night are at the core of the problem; together, they impose significant stress to the organism with deleterious consequences on physical and mental health. SDB increases the risk of obesity, diabetes, depression and anxiety disorders; however, the same health issues are risk factors for SDB. So, which came first, the chicken or the egg? What causes the appearance of the first significant apnoeic events during sleep? These are important questions because although moderate to severe SDB affects ∼500 million adults globally, we still have a poor understanding of the origins of the disease, and the main treatments (and animal models) focus on the symptoms rather than the cause. Because obesity, metabolic dysfunction and stress-related neurological disorders generally appear progressively, we discuss how the development of these diseases can lead to specific anatomical and non-anatomical traits of SDB in males and females while considering the impacts of sex steroids. In light of the growing evidence indicating that the carotid bodies are important sensors of key metabolic and endocrine signals associated with stress and dysmetabolism, we propose that these organs play a key role in the process.
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Affiliation(s)
- Silvia V. Conde
- NOVA Medical School, Faculdade de Ciências Médicas, Universidade NOVA de Lisboa, Lisboa, Portugal
| | - Vsevolod Y Polotsky
- Department of Anesthesiology and Critical Care Medicine, George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | - Vincent Joseph
- Département de Pédiatrie, Université Laval & Research Center of the Québec Heart and Lung Institute, Québec, QC. Canada
| | - Richard Kinkead
- Département de Pédiatrie, Université Laval & Research Center of the Québec Heart and Lung Institute, Québec, QC. Canada
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Zhang LY, Anderson J, Higgins N, Robinson J, Francey S, Burke A, Robinson G, Curtin D, Tay G. Screening for obstructive sleep apnoea in patients with serious mental illness. Australas Psychiatry 2022; 30:615-618. [PMID: 35714679 DOI: 10.1177/10398562221108632] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Patients with serious mental illness (SMI) are at increased risk of obstructive sleep apnoea (OSA). Despite this, OSA is frequently under-recognised in the psychiatric population. This study describes the results of OSA screening in SMI patients. METHOD Patients with SMI attending a metropolitan mental health clinic were screened for OSA using the OSA50, STOP-BANG Questionnaire (SBQ), Epworth Sleep Score (ESS) and the Pittsburgh Sleep Quality Index (PSQI). They were then offered diagnostic sleep testing via ResMed ApneaLinkTM and polysomnography. RESULTS Of the 65 patients recruited, 65% had a primary diagnosis of schizophrenia or schizoaffective disorder, 85% were on antipsychotic medications and the majority were obese. Approximately 50% of patients reported poor sleep quality via the PSQI, in contrast to 12% with elevated daytime sleepiness via the ESS. 46% of our cohort were at risk of OSA due to an elevated OSA50 or SBQ. Of the five patients who agreed to proceed to diagnostic sleep testing, three were diagnosed with OSA. CONCLUSION A high proportion of patients with psychiatric illness are at risk of sleep-disordered breathing. Sleep dissatisfaction is high. The low uptake of sleep investigation requires improved patient engagement to improve OSA diagnosis in this high-risk group.
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Affiliation(s)
- Lai-Ying Zhang
- Thoracic Medicine, 534258The Prince Charles Hospital, Brisbane, QLD, Australia
| | - James Anderson
- Thoracic Medicine, 523457Sunshine Coast University Hospital, Brisbane, QLD, Australia
| | - Niall Higgins
- Metro North Mental Health, The Prince Charles Hospital, Brisbane, QLD, Australia
| | - Jan Robinson
- Sleep Disorders Centre, 67567The Prince Charles Hospital, Brisbane, QLD, Australia
| | - Sonia Francey
- Sleep Disorders Centre, 67567The Prince Charles Hospital, Brisbane, QLD, Australia
| | - Andrew Burke
- Thoracic Medicine, 534258The Prince Charles Hospital, Brisbane, QLD, Australia
| | - Gail Robinson
- Metro North Mental Health, The Prince Charles Hospital, Brisbane, QLD, Australia
| | - Deanne Curtin
- Sleep Disorders Centre, 67567The Prince Charles Hospital, Brisbane, QLD, Australia
| | - George Tay
- Sleep Disorders Centre, 67567The Prince Charles Hospital, Brisbane, QLD, Australia
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Giles JJ, Ling I, McArdle N, Bucks RS, Cadby G, Singh B, Morgan VA, Gabriel L, Waters F. Obstructive Sleep Apnea Is Treatable With Continuous Positive Airway Pressure in People With Schizophrenia and Other Psychotic Disorders. Schizophr Bull 2021; 48:437-446. [PMID: 34581411 PMCID: PMC8886585 DOI: 10.1093/schbul/sbab100] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Obstructive sleep apnea (OSA) is a highly prevalent condition in people living with schizophrenia or other psychotic disorder. Its treatment with continuous positive airway pressure therapy (CPAP) can dramatically improve daytime and physical health function. People with a psychotic disorder, however, are rarely diagnosed and treated and there are no large-scale studies showing evidence of successful treatment with CPAP. Using a retrospective case-control study approach (N = 554), we examined adherence to and effectiveness of a CPAP trial in individuals with comorbid psychotic disorder and OSA (psychosis group, n = 165) referred for a CPAP trial at the West Australian Sleep Disorders Research Institute. Given that antipsychotic medication is an important confounder, we included a psychiatric (non-psychosis) comparison group taking antipsychotic medication (antipsychotic group, n = 82), as well as a nonpsychiatric control group (OSA control group, n = 307) also diagnosed with OSA and referred for CPAP. Variables included OSA symptom response, CPAP engagement, and usage at 3 months. The Psychosis group had the most severe OSA at baseline and they attended fewer clinic appointments overall. However, there were no other group differences either in CPAP adherence or treatment response. CPAP was equally effective in normalizing OSA symptoms and daytime sleepiness in all groups. CPAP usage was longer per night in the Psychosis and Antipsychotic groups, perhaps suggesting a role of sedation from antipsychotic medications. In conclusion, OSA is treatable and CPAP feasible in people with severe mental illness and antipsychotic medications are not a barrier to treatment response.
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Affiliation(s)
- Jamilla J Giles
- School of Psychological Science, University of Western Australia, Perth, Australia
| | - Ivan Ling
- West Australian Sleep Disorders Research Institute, Perth, Australia,Department of Pulmonary Physiology & Sleep Medicine, Sir Charles Gairdner Hospital, Nedlands, Australia
| | - Nigel McArdle
- West Australian Sleep Disorders Research Institute, Perth, Australia,Department of Pulmonary Physiology & Sleep Medicine, Sir Charles Gairdner Hospital, Nedlands, Australia,School of Human Sciences, University of Western Australia, Crawley, Australia
| | - Romola S Bucks
- School of Psychological Science, University of Western Australia, Perth, Australia
| | - Gemma Cadby
- School of Population and Global Health, University of Western Australia, Perth, Australia
| | - Bhajan Singh
- West Australian Sleep Disorders Research Institute, Perth, Australia,Department of Pulmonary Physiology & Sleep Medicine, Sir Charles Gairdner Hospital, Nedlands, Australia,School of Human Sciences, University of Western Australia, Crawley, Australia
| | - Vera A Morgan
- Neuropsychiatric Epidemiology Research Unit, School of Population and Global Health, University of Western Australia, Perth, Australia,Clinical Research Centre, Graylands Hospital, North Metropolitan Health Service-Mental Health, Perth, Australia,Centre for Clinical Research in Neuropsychiatry, Division of Psychiatry, Medical School, University of Western Australia, Perth, Australia
| | - Laura Gabriel
- Clinical Research Centre, Graylands Hospital, North Metropolitan Health Service-Mental Health, Perth, Australia
| | - Flavie Waters
- School of Psychological Science, University of Western Australia, Perth, Australia,Clinical Research Centre, Graylands Hospital, North Metropolitan Health Service-Mental Health, Perth, Australia,To whom correspondence should be addressed; Clinical Research Centre, Gascoyne House, Graylands Hospital, North Metropolitan Health Service-Mental Health, Perth, 6019, Australia; tel: 61-8-9347-6420, fax: 61-8-9384-5128, e-mail: ;
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5
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Mungo A, Hein M, Lanquart JP, Loas G. [Atypical depression as a risk factor for obstructive sleep apnea syndrome in young adults]. L'ENCEPHALE 2021; 48:171-178. [PMID: 34092378 DOI: 10.1016/j.encep.2021.02.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/27/2020] [Revised: 01/24/2021] [Accepted: 02/12/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVES In the literature, several studies have investigated the particular relationship between major depression and obstructive sleep apnoea syndrome (OSAS). However, most of these studies have focused primarily on middle-aged to elderly individuals (≥40 years) which means that this problem has been little studied in young adults (<30 years). Nevertheless, in young adults the prevalence of major depression (particularly its atypical subtype) is not negligible, which seems to justify carrying out additional investigations in order to allow a better understanding of the potential role played by major depression in the pathophysiology of OSAS in this particular subpopulation. The aim of this study was therefore to empirically investigate the prevalence of OSAS in young adults and to study the risk of OSAS associated with major depression in this particular subpopulation. METHODS Polysomnographic and demographic data from 264 young adults were collected from the Erasme Hospital Sleep Laboratory (Brussels, Belgium) database to enable our analyses. During their two-night stay (including a first night of habituation and a night of polysomnography) at the Sleep Laboratory, these individuals underwent a complete somatic assessment (including blood test, electrocardiogram, daytime electroencephalogram and urinalysis), a systematic psychiatric assessment by a unit psychiatrist and an assessment of their complaints related to sleep. These different steps made it possible to systematically diagnose all somatic pathologies, psychiatric disorders according to the diagnostic criteria of the DSM-IV-TR and sleep pathologies according to the diagnostic criteria of the AASM. This allowed the selection of young adults included in our study based on our inclusion and exclusion criteria. Polysomnographic recordings from our Sleep Laboratory were visually scored according to AASM criteria. An obstructive sleep apnoea-hypopnoea index ≥5/hour was used for the diagnosis of OSAS. At the statistical level, in order to allow our analyses, we subdivided our sample of young adults into two groups: a control group without OSAS (n=215) and a patient group with OSAS (n=49). After checking the normal distribution of our data, normally distributed data were analysed with t-tests whereas asymmetrically or dichotomously distributed data were analysed with Wilcoxon tests or Chi2 tests. Univariate regression models were used to study the risk of OSAS associated with major depression (categorized: absent, typical, atypical) in young adults and potential confounding factors. In multivariate regression models, the risk of OSAS associated with major depression (categorized: absent, typical, atypical) in young adults was adjusted only for confounding factors significantly associated with OSAS during univariate analysis. These confounding factors were introduced in a hierarchical manner in the various multivariate regression models constructed. RESULTS The prevalence of OSAS in our population of young adults was 18.6 %. During univariate analyses, atypical depression [OR 2.51 (95% CI 1.18-5.32), p-value=0.014], male gender [OR 4.53 (95% CI 2.20-9.34), P-value <0.001], presence of snoring [OR 2.51 (95% CI 1.33-4.75), P-value=0.005], presence of at least one cardio-metabolic alteration [OR 2.26 (95% CI 1.19-4.28), P-value=0.012], body mass index>30 kg/m2 [OR 4.55 (95% CI 2.07-10.03), P-value <0.001] and ferritin ≥150 μg/L [OR 3.28 (95% CI 1.69-6.36), P-value<0.001] were associated with increased risk of OSAS in our population of young adults. After adjusting for these major confounding factors associated with OSAS (gender, body mass index, cardio-metabolic alterations, ferritin level, and snoring) in the four models studied, multivariate regression analyses confirmed that unlike typical depression, atypical depression [OR 3.09 (95% CI 1.26-7.54), P-value=0.019] was a risk factor for OSAS in young adults. CONCLUSIONS In our study, we demonstrated that the prevalence of OSAS was 18.6 % in young adults referred to the Erasme Hospital Sleep Laboratory. In addition, we have shown that unlike typical depression, atypical depression was associated with an increased risk of OSAS in young adults, which seems to justify more systematic research of this pathology in young adults suffering from atypical depression in order to allow the establishment of adapted therapeutic strategies and avoid the negative consequences associated with the co-occurrence of these two pathologies.
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Affiliation(s)
- A Mungo
- Hôpital Erasme, Service de Psychiatrie et Laboratoire du Sommeil, Université libre de Bruxelles, ULB, route de Lennik 808, 1070 Bruxelles, Belgique.
| | - M Hein
- Hôpital Erasme, Service de Psychiatrie et Laboratoire du Sommeil, Université libre de Bruxelles, ULB, route de Lennik 808, 1070 Bruxelles, Belgique
| | - J-P Lanquart
- Hôpital Erasme, Service de Psychiatrie et Laboratoire du Sommeil, Université libre de Bruxelles, ULB, route de Lennik 808, 1070 Bruxelles, Belgique
| | - G Loas
- Hôpital Erasme, Service de Psychiatrie et Laboratoire du Sommeil, Université libre de Bruxelles, ULB, route de Lennik 808, 1070 Bruxelles, Belgique
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Freeman D, Sheaves B, Waite F, Harvey AG, Harrison PJ. Sleep disturbance and psychiatric disorders. Lancet Psychiatry 2020; 7:628-637. [PMID: 32563308 DOI: 10.1016/s2215-0366(20)30136-x] [Citation(s) in RCA: 263] [Impact Index Per Article: 65.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2020] [Revised: 02/22/2020] [Accepted: 03/17/2020] [Indexed: 01/10/2023]
Abstract
Signs of mental ill health that cut across psychiatric diagnostic categories at high rates are typically viewed as non-specific occurrences, downgraded in importance and disregarded. However, problems not associated with particular diagnoses should be expected if there is shared causation across mental health conditions. If dynamic networks of interacting symptoms are the reality of mental health presentations, then particularly disruptive and highly connected problems should be especially common. The non-specific occurrence might be highly consequential. One non-specific occurrence that is often overlooked is patients' chronic difficulty in getting good sleep. In this Review, we consider whether disrupted sleep might be a contributory causal factor in the occurrence of major types of mental health disorders. It is argued that insomnia and other mental health conditions not only share common causes but also show a bidirectional relationship, with typically the strongest pathway being disrupted sleep as a causal factor in the occurrence of other psychiatric problems. Treating insomnia lessens other mental health problems. Intervening on sleep at an early stage might be a preventive strategy for the onset of clinical disorders. Our recommendations are that insomnia is assessed routinely in the occurrence of mental health disorders; that sleep disturbance is treated in services as a problem in its own right, yet also recognised as a pathway to reduce other mental health difficulties; and that access to evidence-based treatment for sleep difficulties is expanded in mental health services.
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Affiliation(s)
- Daniel Freeman
- Department of Psychiatry, University of Oxford, Oxford, UK; Health National Health Service Foundation Trust, Oxford, UK.
| | - Bryony Sheaves
- Department of Psychiatry, University of Oxford, Oxford, UK; Health National Health Service Foundation Trust, Oxford, UK
| | - Felicity Waite
- Department of Psychiatry, University of Oxford, Oxford, UK; Health National Health Service Foundation Trust, Oxford, UK
| | - Allison G Harvey
- Department of Psychology, University of California, Berkeley, CA, USA
| | - Paul J Harrison
- Department of Psychiatry, University of Oxford, Oxford, UK; Health National Health Service Foundation Trust, Oxford, UK
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Affiliation(s)
- John W Winkelman
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston.,Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston
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8
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Sleep therapeutics and neuropsychiatric illness. Neuropsychopharmacology 2020; 45:166-175. [PMID: 31376815 PMCID: PMC6879486 DOI: 10.1038/s41386-019-0474-9] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2019] [Revised: 07/23/2019] [Accepted: 07/30/2019] [Indexed: 11/08/2022]
Abstract
Alterations in sleep are extremely common in patients with neuropsychiatric illness. In addition, sleep disorders such as insomnia, obstructive sleep apnea, rapid eye movement sleep behavior disorder, and circadian rhythm disorders commonly occur at a rate greater than the general population in neuropsychiatric conditions. Historically, sleep problems have been viewed as symptoms of associated neuropsychiatric disorders. However, there is increasing evidence suggesting a complex inter-relationship with possible bidirectional causality. The inter-relatedness of these conditions represents an opportunity for understanding mechanisms and improving clinical treatment. To the extent that sleep problems affect neuropsychiatric conditions, it may be possible to address sleep problems and have a positive impact on the course of neuropsychiatric illnesses. Further, some treatments for sleep disorders have direct effects on neuropsychiatric illnesses that may be unrelated to their effects on sleep disorders. Similarly, neuropsychiatric conditions and their treatments can affect sleep and sleep disorders. This article reviews available evidence on the effects of therapies for sleep disorders on neuropsychiatric conditions and also secondarily considers the impacts of therapies for neuropsychiatric conditions on sleep. Primary goals of this review are to identify gaps in current research, to determine the extent to which the cross-therapeutic effects of these treatments help to elucidate therapeutic or pathological mechanisms, and to assist clinicians in optimizing therapeutic choice in patients with sleep disorders and neuropsychiatric conditions.
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Grubac Z, Sutulovic N, Ademovic A, Velimirovic M, Rasic-Markovic A, Macut D, Petronijevic N, Stanojlovic O, Hrncic D. Short-term sleep fragmentation enhances anxiety-related behavior: The role of hormonal alterations. PLoS One 2019; 14:e0218920. [PMID: 31269081 PMCID: PMC6609147 DOI: 10.1371/journal.pone.0218920] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Accepted: 06/13/2019] [Indexed: 01/25/2023] Open
Abstract
Introduction The neuroendocrine background of acute sleep fragmentation in obstructive sleep apnea and sleep fragmentation involvement in psychiatric comorbidities, common in these patients, are still largely unknown. The aim of this study was to determine the effects of short-term experimental sleep fragmentation on anxiety -like behavior and hormonal status in rats. Methods Male rats were adapted to treadmill (ON and OFF mode with belt speed set on 0.02m/s and 0.00m/s) and randomized to: 1) treadmill control (TC, only OFF mode); 2) motion, activity control (AC, 10min ON and 30min OFF mode) and 3) sleep fragmentation (SF, 30s ON and 90s OFF mode) group. Six hours later, the animals were tested in the open field, elevated plus maze and light/dark test (n = 8/group). Testosterone, estradiol, progesterone and corticosterone were determined in separate animal cohort immediately upon sleep fragmentation (n = 6/group). Results SF rats showed decreased rearings number, decreased time spent in the central area and increased thigmotaxic index compared to TC and AC rats in the open field test. Similarly, increased anxiety upon sleep fragmentation was observed in the elevated plus maze and the light/dark test. Significantly lower testosterone, estradiol and progesterone levels were determined in SF in comparison to AC and TC groups, while there was no significant difference in the levels of corticosterone. Conclusion Short term sleep fragmentation enhances anxiety-related behavior in rats, which could be partly mediated by the observed hormonal changes presented in the current study in form of testosterone, estradiol and progesterone depletion.
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Affiliation(s)
- Zeljko Grubac
- Laboratory of Neurophysiology, Institute of Medical Physiology “Richard Burian”, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Nikola Sutulovic
- Laboratory of Neurophysiology, Institute of Medical Physiology “Richard Burian”, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Anida Ademovic
- Laboratory of Neurophysiology, Institute of Medical Physiology “Richard Burian”, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Milica Velimirovic
- Institute of Clinical and Medical Biochemistry, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Aleksandra Rasic-Markovic
- Laboratory of Neurophysiology, Institute of Medical Physiology “Richard Burian”, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Djuro Macut
- Clinic of Endocrinology, Diabetes and Metabolic Disease, CCS, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Natasa Petronijevic
- Institute of Clinical and Medical Biochemistry, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Olivera Stanojlovic
- Laboratory of Neurophysiology, Institute of Medical Physiology “Richard Burian”, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Dragan Hrncic
- Laboratory of Neurophysiology, Institute of Medical Physiology “Richard Burian”, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
- * E-mail: ,
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Chung AS, DiGiovanni R, Tseng S, Hustedt JW, Chutkan N. Obstructive Sleep Apnea in Elective Spine Surgery: National Prevalence and Inpatient Outcomes. Global Spine J 2018; 8:550-556. [PMID: 30202707 PMCID: PMC6125927 DOI: 10.1177/2192568217740898] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
STUDY DESIGN Retrospective cohort study. OBJECTIVES Epidemiologic studies suggest that the prevalence of moderate to severe obstructive sleep apnea (OSA) is increasing. OSA has been linked to increased rates of postoperative complications following surgery. Large studies, however, regarding surgical outcomes in this patient population, particularly in the spine literature, are limited. Consequently, the purpose of this study was to assess the prevalence of and postoperative risks conferred by OSA in the elective spine population. METHODS Using data from the National Inpatient Sample from 2008 to 2012, an estimated 56 372 (5.1%) patients with OSA undergoing elective cervical and thoracolumbar spine surgery were selected and compared to 1 052 837 patients without OSA undergoing the same procedures. Our primary outcome measures included postoperative complication rates, inpatient mortality, length of stay, and total hospital charges. RESULTS Patients with OSA were, on average 2.6 years older than those without OSA (P < .001) and had a higher comorbidity burden. The prevalence of OSA increased between 2008 and 2012 from 3.5% to 6.8%; P < .001. OSA was associated with a 3-fold increase in major complications (P < .001) and was confirmed as an independent risk factor for major complications based on multivariate analysis (odds ratio [OR] = 2.82; 95% CI = 2.59-2.79; P < .001). Rates of deep venous thrombosis were doubled in patients with OSA. OSA was determined to be an independent predictor of pulmonary complications (OR = 2.69; 95% CI = 2.59-2.79; P < .001). OSA did not increase the risk of postoperative mortality. CONCLUSIONS Patients with OSA often have multiple concomitant comorbidities and consequently are at increased risk of experiencing a more difficult postoperative course following elective spine surgery. Specifically, increased risks of pulmonary complications and deep venous thrombosis should be anticipated.
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Affiliation(s)
| | | | - Steve Tseng
- University of Arizona College of Medicine, Phoenix, AZ, USA
| | | | - Norman Chutkan
- University of Arizona College of Medicine, Phoenix, AZ, USA
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Acosta-Castro P, Hirotsu C, Marti-Soler H, Marques-Vidal P, Tobback N, Andries D, Waeber G, Preisig M, Vollenweider P, Haba-Rubio J, Heinzer R. REM-associated sleep apnoea: prevalence and clinical significance in the HypnoLaus cohort. Eur Respir J 2018; 52:13993003.02484-2017. [PMID: 29976653 DOI: 10.1183/13993003.02484-2017] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2017] [Accepted: 06/19/2018] [Indexed: 01/14/2023]
Abstract
This study determined the prevalence of rapid eye movement (REM) related sleep-disordered breathing (REM-SDB) in the general population and investigated the associations of REM-SDB with hypertension, metabolic syndrome, diabetes and depression.Home polysomnography (PSG) recordings (n=2074) from the population-based HypnoLaus Sleep Cohort (48.3% men, 57±11 years old) were analysed. The apnoea-hypopnoea index was measured during REM and non-REM sleep (as REM-AHI and NREM-AHI, respectively). Regression models were used to explore the associations between REM-SDB and hypertension, diabetes, metabolic syndrome and depression in the entire cohort and in subgroups with NREM-AHI <10 events·h-1 and total AHI <10 events·h-1The prevalence of REM-AHI ≥20 events·h-1 was 40.8% in the entire cohort. An association between increasing REM-AHI and metabolic syndrome was found in the entire cohort and in both the NREM-AHI and AHI subgroups (p-trend=0.014, <0.0001 and 0.015, respectively). An association was also found between REM-AHI ≥20 events·h-1 and diabetes in both the NREM-AHI <10 events·h-1 (odds ratio (OR) 3.12 (95% CI 1.35-7.20)) and AHI <10 events·h-1 (OR 2.92 (95% CI 1.12-7.63)) subgroups. Systolic and diastolic blood pressure were positively associated with REM-AHI ≥20 events·h-1REM-SDB is highly prevalent in our middle-to-older age sample and is independently associated with metabolic syndrome and diabetes. These findings suggest that an increase in REM-AHI could be clinically relevant.
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Affiliation(s)
- Patricia Acosta-Castro
- Center for Investigation and Research in Sleep (CIRS), University Hospital of Lausanne, Lausanne, Switzerland.,Pulmonary Dept, University Hospital Ramon y Cajal, Madrid, Spain.,P. Acosta-Castro and C. Hirotsu contributed equally to this study as co-first authors
| | - Camila Hirotsu
- Center for Investigation and Research in Sleep (CIRS), University Hospital of Lausanne, Lausanne, Switzerland.,P. Acosta-Castro and C. Hirotsu contributed equally to this study as co-first authors
| | - Helena Marti-Soler
- Institute of Social and Preventive Medicine, University Hospital of Lausanne, Lausanne, Switzerland
| | - Pedro Marques-Vidal
- Dept of Internal Medicine, University Hospital of Lausanne, Lausanne, Switzerland
| | - Nadia Tobback
- Center for Investigation and Research in Sleep (CIRS), University Hospital of Lausanne, Lausanne, Switzerland
| | - Daniela Andries
- Center for Investigation and Research in Sleep (CIRS), University Hospital of Lausanne, Lausanne, Switzerland
| | - Gérard Waeber
- Dept of Internal Medicine, University Hospital of Lausanne, Lausanne, Switzerland
| | - Martin Preisig
- Psychiatry Dept, University Hospital of Lausanne, Lausanne, Switzerland
| | - Peter Vollenweider
- Dept of Internal Medicine, University Hospital of Lausanne, Lausanne, Switzerland
| | - José Haba-Rubio
- Center for Investigation and Research in Sleep (CIRS), University Hospital of Lausanne, Lausanne, Switzerland.,J. Haba-Rubio and R. Heinzer contributed equally to this study as co-last authors
| | - Raphael Heinzer
- Center for Investigation and Research in Sleep (CIRS), University Hospital of Lausanne, Lausanne, Switzerland.,J. Haba-Rubio and R. Heinzer contributed equally to this study as co-last authors
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12
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Hu JM, Lin CS, Chen SJ, Chen CY, Lin CL, Kao CH. Association between obstructive sleep apnea and atopic dermatitis in children: A nationwide, population-based cohort study. Pediatr Allergy Immunol 2018; 29:260-266. [PMID: 29314287 DOI: 10.1111/pai.12853] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/22/2017] [Indexed: 01/08/2023]
Abstract
BACKGROUND Atopic dermatitis (AD) is associated with systemic inflammation and may have a similar pathogenesis as obstructive sleep apnea (OSA). However, to date, studies on the association between AD and OSA are limited. OBJECTIVES This study evaluated the association between OSA and AD in children in a large-scale, population-based cohort. METHODS A total of approximately 120 736 children (<18 years) with newly diagnosed AD and 120 736 age- and sex-matched patients without AD from 2000 to 2007 were identified from Taiwan's National Health Insurance Research Database from 2000 to 2007. The Kaplan-Meier test was used for measuring the cumulative incidence of OSA in each cohort. Cox proportional hazard regression models were used for evaluating the risk of OSA in patients with or without AD between the two cohorts. RESULTS The Kaplan-Meier analysis revealed that the cumulative incidence curves of OSA were significantly higher in patients with AD than in those without AD (log-rank test, P < .001). After adjusting for age, sex, urbanization level, and comorbidities, patients with AD had a higher risk of OSA than those without AD (adjusted hazard ratio = 1.86, 95% confidence interval = 1.43-2.42). Compared with patients without AD, patients with AD exhibited a higher risk of developing OSA, irrespective of underlying comorbidities. CONCLUSION This nationwide, population-based cohort study revealed an increased risk of OSA in children with AD. Therefore, comprehensive evaluation and aggressive risk reduction for OSA are recommended in these patients.
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Affiliation(s)
- Je-Ming Hu
- Division of Colorectal Surgery, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan.,Graduate Institute of Medical Sciences, National Defense Medical Center, Taipei, Taiwan.,Department of Emergency Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Chin-Sheng Lin
- Division of Cardiology, Department of Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Sy-Jou Chen
- Department of Emergency Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan.,Graduate Institute of Injury Prevention and Control, College of Public Health, Taipei Medical University, Taipei, Taiwan
| | - Chao-Yang Chen
- Division of Colorectal Surgery, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Cheng-Li Lin
- Management Office for Health Data, China Medical University Hospital, Taichung, Taiwan.,College of Medicine, China Medical University, Taichung, Taiwan
| | - Chia-Hung Kao
- Graduate Institute of Clinical Medical Science and School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan.,Department of Nuclear Medicine and PET Center, China Medical University Hospital, Taichung, Taiwan.,Department of Bioinformatics and Medical Engineering, Asia University, Taichung, Taiwan
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13
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Timkova V, Nagyova I, Reijneveld SA, Tkacova R, van Dijk JP, Bültmann U. Are disease severity, sleep-related problems, and anxiety associated with work functioning in patients with obstructive sleep apnoea? Disabil Rehabil 2018; 41:2164-2174. [DOI: 10.1080/09638288.2018.1460626] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Affiliation(s)
- Vladimira Timkova
- Department of Social and Behavioural Medicine, Faculty of Medicine, PJ Safarik University in Kosice, Kosice, Slovakia
- Graduate School Kosice Institute for Society and Health, PJ Safarik University in Kosice, Kosice, Slovakia
| | - Iveta Nagyova
- Department of Social and Behavioural Medicine, Faculty of Medicine, PJ Safarik University in Kosice, Kosice, Slovakia
| | - Sijmen A. Reijneveld
- University of Groningen Department, University Medical Center Groningen, Department of Health Sciences, Community & Occupational Medicine, Groningen, the Netherlands
| | - Ruzena Tkacova
- Department of Pneumology and Phtiseology, Faculty of Medicine, PJ Safarik University in Kosice, Kosice, Slovakia
| | - Jitse P. van Dijk
- Graduate School Kosice Institute for Society and Health, PJ Safarik University in Kosice, Kosice, Slovakia
- University of Groningen Department, University Medical Center Groningen, Department of Health Sciences, Community & Occupational Medicine, Groningen, the Netherlands
| | - Ute Bültmann
- University of Groningen Department, University Medical Center Groningen, Department of Health Sciences, Community & Occupational Medicine, Groningen, the Netherlands
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14
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Higher Risk for Obstructive Sleep Apnea in Chronic Treatment-Resistant Depression. IRANIAN JOURNAL OF PSYCHIATRY AND BEHAVIORAL SCIENCES 2018. [DOI: 10.5812/ijpbs.10718] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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15
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Escobar-Córdoba F, Echeverry-Chabur J. Repercusiones psiquiátricas del síndrome de apnea-hipopnea obstructiva del sueño (SAHOS). REVISTA DE LA FACULTAD DE MEDICINA 2017. [DOI: 10.15446/revfacmed.v65n1sup.59542] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
La apnea del sueño es un síndrome que afecta múltiples sistemas y produce variados síntomas. En el presente artículo se revisan las enfermedades psiquiátricas más frecuentes asociadas a este y la necesidad de realizar un diagnóstico adecuado y un tratamiento interdisciplinario. La entidad que más se ha podido encontrar en los pacientes con apnea del sueño es la depresión y se piensa que se debe a la fragmentación del sueño, la cual altera la producción de neurotransmisores a nivel cerebral. La ansiedad es la segunda entidad con mayor frecuencia, quizás debido a la liberación de catecolaminas durante la noche. Existen otras sintomatologías asociadas a la apnea del sueño que deben ser revisadas y que mejorarían con un tratamiento adecuado, así como también mejoraría la calidad de vida de los pacientes, pues la atención, la concentración y la memoria incrementarían o disminuirían la irritabilidad y otros síntomas.
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16
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Chang CH, Chen SJ, Liu CY. Pediatric sleep apnea and depressive disorders risk: A population-based 15-year retrospective cohort study. PLoS One 2017; 12:e0181430. [PMID: 28708880 PMCID: PMC5510869 DOI: 10.1371/journal.pone.0181430] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2017] [Accepted: 06/30/2017] [Indexed: 01/08/2023] Open
Abstract
Background Studies have shown a higher risk of depressive disorders in children with sleep apnea than in those without sleep apnea. However, the association between sleep apnea and subsequent depressive disorders in the pediatric population remains undetermined. Thus, this study investigated the risk of depressive disorders among pediatric patients with sleep apnea. Methods In this study, the population-based National Health Insurance Research Database of Taiwan was used to identify patients who had first been diagnosed with sleep apnea between 1999 and 2013. Patients with sleep apnea who were younger than 18 years were included in the sleep apnea group. Controls (those without sleep apnea) were matched to patients with sleep apnea at a 1:10 ratio by age, sex, and index year. Patients who had baseline or inherited depressive disorders before the enrollment date were excluded. The two groups were followed up until December 31, 2013. The primary endpoint was the occurrence of one or more depressive disorders. Results At the end of this study, 6,237 children had been enrolled, comprising 567 children with sleep apnea and 5,670 children without sleep apnea. During the mean follow-up period of 5.87 years, a total of 77 children (1.23%) developed one or more depressive disorders; 14 (2.46%) from the sleep apnea group and 63 (1.11%) from the control group. Kaplan–Meier analysis showed that children with sleep apnea had a significantly higher risk of depressive disorders (log-rank test, p = 0.002). After adjusting for covariates, the risk of subsequent depressive disorders among children with sleep apnea was still significantly higher (hazard ratio [HR] = 2.25; 95% confidence interval [CI] = 1.25–4.05; p = 0.006). Moreover, boys with sleep apnea had a significantly higher risk than those without sleep apnea (adjusted HR = 3.77; 95% CI, 1.82–7.54; p < 0.001). Furthermore, in sleep apnea group, children older than 12 years of age had more risk to depression (hazard ratio (HR) = 7.1833, 95% confidence interval (CI), 2.3734 to 21.7411; p = 0.0004). Conclusions This study found a significantly higher subsequent risk of depressive disorders in children with sleep apnea, particularly boys and those older than 12 years of age. The study findings strongly suggest that clinicians should provide psychological evaluation and supportive care for children with sleep apnea, in addition to medical treatment.
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Affiliation(s)
- Chun-Hung Chang
- Department of Psychiatry, China Medical University Hospital, Taichung, Taiwan, R.O.C
- Institute of Clinical Medicine, China Medical University, Taichung, Taiwan, R.O.C
- Department of Nursing, Cardinal Tien Junior College of Healthcare and Management, Taipei, Taiwan, R.O.C
| | - Shaw-Ji Chen
- Department of Psychiatry, Mackay Memorial Hospital Taitung Branch, Taitung, Taiwan, R.O.C
- Mackay Junior College of Medicine, Nursing, and Management, Taipei, Taiwan, R.O.C
- Institute of Medical Sciences, Tzu Chi University, Hualien, Taiwan, Taiwan, R.O.C
| | - Chieh-Yu Liu
- Biostatistical Consulting Lab, Department of Midwifery and Women Health Care, National Taipei University of Nursing and Health Sciences, Taipei, Taiwan, R.O.C
- Department of Speech Language Pathology and Audiology, National Taipei University of Nursing and Health Sciences, Taipei, Taiwan, R.O.C
- * E-mail:
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17
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Sleep apnea is associated with an increased risk of mood disorders: a population-based cohort study. Sleep Breath 2016; 21:243-253. [PMID: 27495797 DOI: 10.1007/s11325-016-1389-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2016] [Revised: 07/07/2016] [Accepted: 07/25/2016] [Indexed: 10/21/2022]
Abstract
PURPOSE The symptoms of sleep apnea, such as sleep fragmentation and oxygen desaturation, might be risk factors for subsequent mood disorder (MD), but associations between sleep apnea and MD remain unclear. This nationwide population-based study thus aimed to identify the risk of MD in patients with vs. without sleep apnea. METHODS This cohort study used data from the National Health Insurance database. In total, 5415 patients diagnosed with sleep apnea between 2000 and 2010 were evaluated, and 27,075 matched non-sleep apnea enrollees were included as a comparison cohort. All subjects were followed until 2011. The Cox proportional hazard ratio (HR) was used to investigate the relationship between MD and sleep apnea while controlling covariates and comorbidities of sleep apnea. RESULTS Of 5415, 154 patients with sleep apnea (2.84 %) were diagnosed with MD during the follow-up period in comparison with 306 of 27,075 individuals (1.13 %) without antecedent sleep apnea. After adjusting for the selected factors and comorbidities, we found that patients with sleep apnea were from 1.82- to 2.07-fold greater risk of MD than the comparisons. Of the three subcategories of MD (major depressive disorder, bipolar disorder, and unspecified MD), sleep apnea had the highest predisposing risk with respect to major depressive disorder (adjusted HR from 1.82 to 2.07) and bipolar disorder (adjusted HR from 2.15 to 3.24). CONCLUSIONS There is a greater likelihood of MD manifesting in patients with a history of sleep apnea. Health professionals are thus advised to carefully monitor the psychological impacts of sleep apnea.
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18
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Abstract
Psychiatric disorders and obstructive sleep apnea (OSA) are often comorbid. However, there is limited information on the impact of psychotropic medications on OSA symptoms, on how to manage psychiatric pharmacotherapy in patients presenting with OSA, or on the effectiveness and challenges of OSA treatments in patients with comorbid mental illness. As such, the objective of this article is to provide an overview of some epidemiological aspects of OSA and treatment considerations in the management of OSA in individuals with comorbid psychiatric disorders. Predefined keywords were used to search for relevant literature in electronic databases. Data show that OSA is particularly prevalent in patients with psychiatric disorders. The medical care that patients with these comorbidities require can be challenging, as some of the psychiatric medications used by these patients may exacerbate OSA symptoms. As such, continuous positive airway pressure continues to be the first-line treatment, even in patients with psychiatric comorbidity. However, more controlled studies are required, particularly to determine continuous positive airway pressure compliance in patients with mental illness, the impact of treating OSA on psychiatric symptoms, and the impact of the use of psychotropic medications on OSA symptoms.
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Affiliation(s)
- Taryn Heck
- Pharmacy Department, University of Alberta Hospital, Alberta Health Services, Edmonton, AB, Canada
| | - Monica Zolezzi
- Clinical Pharmacy and Practice, College of Pharmacy, Qatar University, Doha, Qatar
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19
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Bawo OJ, Chinwe FI, Atim OA. Risk of obstructive sleep apnoea syndrome among in-patients at a neuropsychiatric hospital in Nigeria: a short report. Afr Health Sci 2015; 15:967-71. [PMID: 26957988 DOI: 10.4314/ahs.v15i3.34] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND/OBJECTIVES Sleep problems are commonly reported by persons with severe mental illness. Obstructive sleep apnoea syndrome (OSA) is commonly co-morbid with mental illness. Screening for OSA and its subsequent management may improve outcomes in this patient population. We screened for risk of OSA among in-patients with severe mental illness to determine its prevalence as well as its correlates using a socio-demographic questionnaire and the Berlin questionnaire. METHODS A cross sectional descriptive exploratory survey of in-patients (n=89) at a regional Neuro- Psychiatric hospital using a socio-demographic questionnaire and the Berlin questionnaire. RESULTS Eighteen patients (18/89; 20.9%) were classed as high risk for OSA. High risk for OSA was significantly associated with a higher body mass index; BMI (p<0.01), but not gender (p=0.53), diagnoses (p=0.84), co-morbidity (p=0.73) or use of atypical antipsychotics (p=0.48). CONCLUSION Patients with severe mental illness are at high risk for OSA with being overweight higher BMI significantly associated with this high risk.
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20
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Su VYF, Chen YT, Lin WC, Wu LA, Chang SC, Perng DW, Su WJ, Chen YM, Chen TJ, Lee YC, Chou KT. Sleep Apnea and Risk of Panic Disorder. Ann Fam Med 2015; 13. [PMID: 26195676 PMCID: PMC4508172 DOI: 10.1370/afm.1815] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
PURPOSE Epidemiological studies have identified a trend in the development of depressive and anxiety disorders following a diagnosis of sleep apnea. The relationship between sleep apnea and subsequent panic disorder, however, remains unclear. METHODS Using a nationwide database, the Taiwan National Health Insurance Research Database, patients with sleep apnea and age-, sex-, income-, and urbanization-matched control patients who did not have sleep apnea were enrolled between 2000 and 2010. Patients with a prior diagnosis of panic disorder before enrollment were excluded. The 2 cohorts were observed until December 31, 2010. The primary endpoint was occurrence of newly diagnosed panic disorder. RESULTS A total of 8,704 sleep apnea patients and 34,792 control patients were enrolled. Of the 43,496 patients, 263 (0.60%) suffered from panic disorder during a mean follow-up period of 3.92 years, including 117 (1.34%) from the sleep apnea cohort and 146 (0.42%) from the control group. The Kaplan-Meier analysis revealed a predisposition of patients with sleep apnea to develop panic disorder (log-rank test, P <.001). After multivariate adjustment, the hazard ratio for subsequent panic disorder among the sleep apnea patients was 2.17 (95% confidence interval, 1.68-2.81; P <.001). CONCLUSIONS Sleep apnea appears to confer a higher risk for future development of panic disorder.
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Affiliation(s)
- Vincent Yi-Fong Su
- Center of Sleep Medicine, Taipei Veterans General Hospital, Taipei, Taiwan Department of Chest Medicine, Taipei Veterans General Hospital, Taipei, Taiwan School of Medicine, National Yang-Ming University, Taipei, Taiwan Institute of Clinical Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Yung-Tai Chen
- School of Medicine, National Yang-Ming University, Taipei, Taiwan Department of Medicine, Heping-Fuyou Branch, Taipei City Hospital, Taipei, Taiwan
| | - Wei-Chen Lin
- Center of Sleep Medicine, Taipei Veterans General Hospital, Taipei, Taiwan School of Medicine, National Yang-Ming University, Taipei, Taiwan Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Li-An Wu
- Department of Radiology, Heping-Fuyou Branch, Taipei City Hospital, Taipei, Taiwan
| | - Shi-Chuan Chang
- Center of Sleep Medicine, Taipei Veterans General Hospital, Taipei, Taiwan Department of Chest Medicine, Taipei Veterans General Hospital, Taipei, Taiwan School of Medicine, National Yang-Ming University, Taipei, Taiwan Institute of Emergency and Critical Care Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Diahn-Warng Perng
- Center of Sleep Medicine, Taipei Veterans General Hospital, Taipei, Taiwan Department of Chest Medicine, Taipei Veterans General Hospital, Taipei, Taiwan School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Wei-Juin Su
- Department of Chest Medicine, Taipei Veterans General Hospital, Taipei, Taiwan School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Yuh-Min Chen
- Department of Chest Medicine, Taipei Veterans General Hospital, Taipei, Taiwan School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Tzeng-Ji Chen
- School of Medicine, National Yang-Ming University, Taipei, Taiwan Department of Family Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Yu-Chin Lee
- Department of Chest Medicine, Taipei Veterans General Hospital, Taipei, Taiwan School of Medicine, National Yang-Ming University, Taipei, Taiwan Institute of Clinical Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Kun-Ta Chou
- Center of Sleep Medicine, Taipei Veterans General Hospital, Taipei, Taiwan Department of Chest Medicine, Taipei Veterans General Hospital, Taipei, Taiwan School of Medicine, National Yang-Ming University, Taipei, Taiwan Institute of Clinical Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan
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21
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Mieczkowski BP, Oduguwa A, Kowatch RA, Splaingard M. Risk factors for sleep apnea in children with bipolar disorder. J Affect Disord 2015; 167:20-4. [PMID: 25082109 DOI: 10.1016/j.jad.2014.05.037] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2014] [Accepted: 05/23/2014] [Indexed: 11/29/2022]
Abstract
BACKGROUND While studies have suggested an increased prevalence of Obstructive Sleep Apnea (OSA) in adults with Bipolar Disorder (BPD), little is published about children with BPD. Behavioral difficulties including emotional liability, depression and poor school performance are commonly reported in children with either BPD or OSA. Comorbid medical disorders may exacerbate the course of BPD. We reviewed demographic and polysomnogram characteristics of children with BPD to help outpatient identification of OSA. METHODS A single center retrospective chart review of children with BPD referred for a polysomnogram (PSG) over a ten-year period was conducted. There were 27 children identified whose diagnosis of BPD was independently verified by a child psychiatrist using DSM-IV standard criteria. RESULTS Six (22%) children had OSA with a median apnea-hyponea index of 7.5 events per hour. Variables that were significantly different between the OSA and non-OSA groups were: median BMI (47 vs 30 kg/m(2), p=0.001); sleep efficiency (78.2% vs 91%, p=0.009); and oxygen saturation nadir (82% vs 92%, p=0.0003). There was no difference found in snoring percentage on PSG between the two groups. LIMITATIONS The retrospective design from a single tertiary center limited the cohort size. Only secondary verification of the diagnosis of BPD from the available medical record was possible. CONCLUSIONS Our findings suggest that extreme obesity (BMI >40 kg/m(2)), oxygen desaturation during sleep and frequent nocturnal awakenings are associated with OSA in children with BPD. Traditional clinical parameters for obesity and snoring, per se, are poor predictors of OSA in children with BPD.
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Affiliation(s)
- Brian P Mieczkowski
- Department of Internal Medicine, Division of Pulmonary, Allergy, Critical Care and Sleep Medicine, The Ohio State University Wexner Medical Center, Columbus, OH, USA.
| | - Abimdola Oduguwa
- The College of Medicine, The Ohio State University Wexner Medical Center, Columbus, OH, USA.
| | - Robert A Kowatch
- Department of Psychiatry, The Ohio State University Wexner Medical Center, Columbus, OH, USA; Center for Innovation in Pediatric Practice, Nationwide Children׳s Hospital, Columbus, OH, USA.
| | - Mark Splaingard
- Department of Pulmonary Medicine, Sleep Disorder Center, Nationwide Children׳s Hospital, Columbus, OH, USA.
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22
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Gupta MA, Simpson FC. Obstructive sleep apnea and psychiatric disorders: a systematic review. J Clin Sleep Med 2015; 11:165-75. [PMID: 25406268 DOI: 10.5664/jcsm.4466] [Citation(s) in RCA: 182] [Impact Index Per Article: 20.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2014] [Accepted: 10/13/2014] [Indexed: 12/11/2022]
Abstract
STUDY OBJECTIVES Obstructive sleep apnea (OSA) has been associated with psychiatric pathology. Psychiatric comorbidity in OSA may affect patient quality of life and adherence to CPAP. A focused evaluation of OSA in highly selected groups of primarily psychiatric patients may provide further insights into the factors contributing to comorbidity of OSA and psychopathology. The goal of this study is to examine the prevalence and treatment of OSA in psychiatric populations. METHODS A systematic review following the PRISMA guidelines was conducted to determine the prevalence of OSA in schizophrenia and other psychotic disorders, mood disorders, and anxiety disorders, and to examine potential interventions. The PubMed, EMBASE, and PsycINFO databases were searched (last search April 26, 2014) using keywords based on the ICD-9-CM coding for OSA and the DSM-IV-TR diagnostic groups. RESULTS The search retrieved 47 records concerning studies of OSA in the selected disorders. The prevalence studies indicate that there may be an increased prevalence of OSA in individuals with major depressive disorder (MDD) and posttraumatic stress disorder (PTSD), despite considerable heterogeneity and a high risk of bias. There was insufficient evidence to support increased OSA in schizophrenia and psychotic disorders, bipolar and related disorders, and anxiety disorders other than PTSD. Studies of treatment of OSA indicate an improvement in both OSA and psychiatric symptoms. CPAP adherence was reduced in veterans with PTSD. CONCLUSIONS OSA prevalence may be increased in MDD and PTSD. In individuals with OSA and psychiatric illness, treatment of both disorders should be considered for optimal treatment outcomes.
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Affiliation(s)
- Madhulika A Gupta
- Department of Psychiatry, Schulich School of Medicine and Dentistry, University of Western Ontario, London, Ontario, Canada
| | - Fiona C Simpson
- Department of Psychiatry, Schulich School of Medicine and Dentistry, University of Western Ontario, London, Ontario, Canada
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23
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de Araújo AN, do Nascimento MA, de Sena EP, Baptista AF. Temporomandibular disorders in patients with schizophrenia using antipsychotic agents: a discussion paper. Drug Healthc Patient Saf 2014; 6:21-7. [PMID: 24648768 PMCID: PMC3956479 DOI: 10.2147/dhps.s57172] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Patients with psychiatric problems show a tendency to develop temporomandibular disorders (TMD). Particularly, patients with schizophrenia are quite likely to have signs and symptoms of TMD due to the impairment of their oral health, the use of antipsychotic drugs, and other general health problems. In nonschizophrenic populations, TMD have been considered as the main cause of nondental pain in the orofacial region, involving mechanisms associated with changes in masticatory activity at the cortical and neuromuscular levels. Individuals with schizophrenia do not usually complain of pain, and TMD is misdiagnosed in this population. In this paper, we aimed to review the clinical aspects of TMD in people with schizophrenia on antipsychotic drug therapy.
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Affiliation(s)
- Arão Nogueira de Araújo
- Postgraduate Program in Interactive Processes of Organs and Systems, Federal University of Bahia, Salvador, Brazil
| | - Marion Alves do Nascimento
- Postgraduate Program in Interactive Processes of Organs and Systems, Federal University of Bahia, Salvador, Brazil
| | - Eduardo Pondé de Sena
- Postgraduate Program in Interactive Processes of Organs and Systems, Federal University of Bahia, Salvador, Brazil ; Department of Pharmacology, Institute of Health Sciences, Federal University of Bahia, Salvador, Brazil
| | - Abrahão Fontes Baptista
- Department of Biomorphology, Institute of Health Sciences, Federal University of Bahia, Salvador, Brazil ; Postgraduate Program in Medicine and Health, Federal University of Bahia, Salvador, Brazil
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Tien KJ, Chou CW, Lee SY, Yeh NC, Yang CY, Yen FC, Wang JJ, Weng SF. Obstructive sleep apnea and the risk of atopic dermatitis: a population-based case control study. PLoS One 2014; 9:e89656. [PMID: 24586942 PMCID: PMC3934912 DOI: 10.1371/journal.pone.0089656] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2013] [Accepted: 01/24/2014] [Indexed: 01/04/2023] Open
Abstract
Background Obstructive sleep apnea (OSA) is associated with systemic inflammation and induces various comorbid medical diseases. To date, no study has explored the relationship between OSA and atopic dermatitis (AD), an inflammatory and autoimmune skin disorder. This study investigated the longitudinal risk for AD in patients with OSA. Methods A random sample of 1,000,000 individuals from Taiwan's National Health Insurance database was collected. From this sample, 1222 patients with newly-diagnosed OSA between 2000 and 2005 were identified and compared with a matched cohort of 18330 patients without OSA. All patients were tracked for 5.5 years from the index date in order to identify which patients subsequently developed AD. Results During the 5.5-year follow-up period, the incidence rates of AD in the OSA cohort and comparison groups were 9.81 and 6.21 per 1000 person-years, respectively. After adjustment for age, gender, diabetes, hypertension, coronary heart disease, obesity, allergy, allergic rhinitis, asthma, monthly income, and geographic location, patients with OSA were 1.5-times more likely to develop AD than patients without OSA (95% CI = 1.15–1.95, p = 0.0025). The hazard risk for AD was greater in male OSA patients and young OSA patients (0–18 and 19–34 years), adjusted HRs being 1.53 (95% CI = 1.14–2.06, p = 0.005), 4.01(95% CI = 1.57–10.26, p = 0.0038) and 1.75(95% CI = 1.00–3.04, p = 0.0483), respectively. The log-rank test indicated that OSA patients <35-years-old had significantly higher cumulative incidence rates of AD than those patient of the same age in the comparison group (p = 0.0001). Conclusion Patients with OSA, especially male patients and younger patients, are at an increased risk for AD later in life.
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Affiliation(s)
- Kai-Jen Tien
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Chi Mei Medical Center, Tainan, Taiwan
- Center of General Education, Chia Nan University of Pharmacy and Science, Tainan, Taiwan
| | - Chien-Wen Chou
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Chi Mei Medical Center, Tainan, Taiwan
| | - Shang-Yu Lee
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Chi Mei Medical Center, Tainan, Taiwan
| | - Nai-Cheng Yeh
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Chi Mei Medical Center, Tainan, Taiwan
| | - Chwen-Yi Yang
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Chi Mei Medical Center, Tainan, Taiwan
| | - Feng-Chieh Yen
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Chi Mei Medical Center, Tainan, Taiwan
| | - Jhi-Joung Wang
- Department of Medical Research, Chi Mei Medical Center, Tainan, Taiwan
| | - Shih-Feng Weng
- Department of Medical Research, Chi Mei Medical Center, Tainan, Taiwan
- Department of Hospital and Health Care Administration, Chia Nan University of Pharmacy and Science, Tainan, Taiwan
- * E-mail:
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Abstract
BACKGROUND Obstructive sleep apnoea (OSA) is often overlooked in the context of schizophrenia because its hallmark, daytime sleepiness, is so easily attributable to antipsychotic drugs. This is a special problem for women. AIMS To underscore the importance of diagnosing and treating OSA in women with schizophrenia. METHODS A review of the recent literature (search terms: Obstructive Sleep Apnoea; Schizophrenia; Women (or Gender); Obesity; Antipsychotics; Continuous Positive Airway Pressure (CPAP)) as it applies to a composite case vignette taken from the files of a specialty clinic that treats women with psychosis. RESULTS The rate of OSA in women who are both obese and postmenopausal is very similar to that of men. Family history, smoking, and the use of tobacco, alcohol and of antipsychotic medication increase the risk. Despite reluctance, patients with schizophrenia generally agree to undergo sleep studies. Compliance with CPAP is difficult, but can be aided by the physician and is, on the whole, relatively high in women. CPAP improves sleep parameters and may also improve cardiometabolic and cognitive indices, although this still needs to be more fully researched. CONCLUSION Schizophrenia and untreated OSA are both associated with high mortality rates in women as well as men.
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Affiliation(s)
- Mary V Seeman
- Department of Psychiatry, University of Toronto , Ontario , Canada
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