Prevalence of obstructive sleep apnea as assessed by polysomnography in psychiatric patients with sleep-related problems

Mapping the comorbidome: A novel analysis of the associations between obstructive sleep apnea and its comorbidities in Colombia

IntroductionObstructive sleep apnea (OSA) is linked to a complex network of comorbidities, including cardiovascular, metabolic, neurological, and oncological diseases. The comorbidome visually maps disease associations, highlighting the interconnected comorbidities of OSA, whose incidence and severity are strongly correlated.MethodsA retrospective cohort study was conducted between 2005 and 2020 to identify the comorbidities most frequently associated with OSA through a comprehensive comorbidity map. The prevalence of each comorbidity was calculated as a percentage, and a detailed analysis was performed to examine the relationship between these comorbidities and the severity of OSA. This graphic represents all comorbidities with significant associations to OSA, where the size of each bubble is proportional to the prevalence of the disease within the cohort, and the proximity to the center reflects the strength of the association.ResultsA total of 3043 patients diagnosed with OSA were included, of whom 51.1% (1154/3043) had severe OSA, 29.2% (889/3043) had moderate OSA, and 19.7% (600/3043) had mild OSA. The average age was 57.6 years (SD ± 15.32), and 65.6% (1995/3043) were men. Among patients with mild OSA, hypertension was present in 48.0% (288/600), in moderate OSA in 53.0% (470/889), and in severe OSA in 58.5% (909/1554). Renal failure (OR: 9.39; 95% CI: 3.7-23.84), cardiovascular disease (OR: 7.73; 95% CI: 3.92-15.21), dementia (OR: 6.98; 95% CI: 2.85-17.11), hemiplegia/stroke sequelae (OR: 6.90; 95% CI: 2.02-23.51), smoking (OR: 5.54; 95% CI: 2.74-11.21), and diabetes (OR: 4.34; 95% CI: 2.02-9.35) were associated with mild OSA. Hemiplegia/stroke sequelae (OR: 10.11; 95% CI: 3.8-26.89), cardiovascular disease (OR: 9.77; 95% CI: 6.18-15.46), chronic pulmonary disease (OR: 7.48; 95% CI: 4.76-11.77), and dementia (OR: 6.80;95% CI: 3.37-13.71) were associated with moderate OSA. Dementia (OR: 10.59; 95% CI: 6.41-17.5), leukemia and lymphoma (OR: 7.49; 95% CI: 2-28.1), chronic pulmonary disease (OR: 7.24; 95% CI: 5.33-9.83), hemiplegia or stroke sequelae (OR: 6.33; 95% CI: 3.3-12.16), and renal failure (OR: 6.10; 95% CI: 3.97-9.36) were associated with severe OSA.ConclusionThe most prevalent comorbidities were hypertension, smoking, and cardiovascular disease, with a higher incidence in patients with severe OSA. Additionally, a significant association was observed between certain comorbidities and mortality, particularly conditions such as renal failure and dementia. Malignant or neoplastic diseases were related to severe OSA.

Sex and age-related differences of the mental health risk in obstructive sleep apnea: A nationwide population-based cohort study

BACKGROUND

Obstructive sleep apnea (OSA) and psychiatric disorders often coexist, affecting patient outcomes and treatment responses. This relationship, particularly the risk of psychiatric conditions in OSA patients, merits further investigation considering age and sex differences.

METHODS

Utilizing the South Korean National Health Insurance claims database (2010-2019), this nationwide-population-based, retrospective study identified OSA patients and matched them with controls based on age and sex. Psychiatric disorders were defined using ICD-10 codes for depression and anxiety. Multivariable logistic regression models, adjusted for demographics and comorbidities, evaluated the association between OSA and psychiatric disorders, with detailed subgroup analyses by age and sex.

RESULTS

Among the 103,785 matched pairs, OSA patients had significantly higher odds of depressive disorders [adjusted OR = 1.62 (95 % CI: 1.60-1.63)] and anxiety disorders [adjusted OR = 1.56 (95 % CI: 1.54-1.58)] compared to controls. Females with OSA were particularly susceptible to these psychiatric conditions. The risk of psychiatric disorders in OSA patients increased with age, peaking for depression between 60 and 79 years and for anxiety between 40 and 59 years, before slightly declining in the oldest cohort.

CONCLUSION

OSA is significantly associated with an increased risk of depressive and anxiety disorders, with pronounced vulnerabilities observed among females and specific age groups. These findings underscore the need for age- and sex-specific considerations in managing OSA and its psychiatric comorbidities, emphasizing a more individualized approach to treatment to enhance patient outcomes.

Barriers and facilitators to detection and treatment of obstructive sleep apnoea syndrome in people with severe mental illnesses, qualitative interview study and referrer survey

Obstructive sleep apnoea syndrome (OSAS) is a relatively common condition. It has a range of negative health and quality of life implications, but there are established tests to detect it, and recommended treatment pathways which have been well tested. OSAS is prevalent in people with severe mental illness (SMI), and research suggests it is under-detected in this group. This study aimed to examine and explore barriers and facilitators to the detection and treatment of OSAS in people with severe mental illnesses. Staff and patients with a range of relevant experiences were interviewed, and a large scale survey of potential OSAS referrers was conducted. Interviews were analysed thematically, survey responses were summarised descriptively, and results are presented together for comparison and enhanced interpretation. The results highlight a lack of awareness of OSAS outside of specialist sleep services, resulting in poor detection and treatment of OSAS in people with SMI. Comorbidities, symptoms and circumstances of this group may make the presence of OSAS less obvious, and can make diagnosis and adapting to treatment more difficult, but also emphasise the benefits of successful continuous positive airway pressure (CPAP) treatment in this group. The challenges of adapting to CPAP were described and acknowledged, but the impact of successful CPAP was for some life changing. The harm of delayed diagnosis was perceived as unjust. We recommend increased screening for OSAS in people with SMI, supported by increased education and training about OSAS in staff who work with people with severe mental illnesses, and increased awareness in service users and carers.

Sleep apnea evokes right hemisphere dominance and psychological disorders: An exploratory study

BACKGROUND

Obstructive sleep apnea (OSA) is considered one of the major causes of sleep disorders and psychological disorders in individuals. Brain asymmetry (BA) demonstrates individual hemispheric activity and psychological disorders. This study aimed to explore the characteristics of BA and psychology in OSA.

METHODS

Enrolment of patients for sleep assessment at the Sleep Medicine Center. Clinical characteristics, handedness, and psychological scales were prospectively collected from subjects. Subsequently, EEG power in alpha, beta, and theta bilaterally was calculated for the rest and sleep phases.

RESULTS

A total of 152 OSA and 21 non-OSA subjects were included in the study. In the frontal, central and occipital regions, OSA exhibited increased interhemispheric asymmetry with increasing apnea-hypopnea index (AHI) during rest and sleep. Simultaneously, the results showed that greater activity in the right hemisphere was positively associated with anxiety and extraversion, while inversely with positive and lie scale. In addition, the results show that OSA contributes to abnormal BA fluctuations during sleep.

CONCLUSIONS

Our results suggest that sleep disorders associated with apnea-hypopnea and arousal may contribute to increased BA during sleep. Such changes may persist into wakefulness with psychological traits.

Orexin receptor antagonists in the treatment of insomnia associated with psychiatric disorders: a systematic review

Insomnia is highly comorbid in patients with psychiatric disorders, including depression, bipolar disorder, and substance use disorders, and should be treated as an independent condition. Dual orexin receptor antagonists (DORAs) have been investigated as a treatment for chronic insomnia. The objective of this systematic review was to examine evidence for two DORAs, lemborexant and suvorexant, as treatments for insomnia comorbid with a psychiatric disorder. We searched PubMed, Cochrane, and Embase from their inception until January and April 2023, and included studies examining suvorexant and lemborexant for treating insomnia comorbid with psychiatric disorders. We also manually searched clinical trial registries ( https://clinicaltrials.gov and https://www.umin.ac.jp/ctr ). Randomized clinical trials and observational/cohort studies were included. We identified 18 studies from PubMed, Cochrane, and Embase and three studies from clinicaltrials.gov and UMIN. Of the 21 reports, four were completed/terminated randomized clinical trials, eight were ongoing clinical trials, and nine were observational studies. We identified evidence for switching from benzodiazepine receptor agonists to a DORA, or using a DORA as add-on therapy and, therefore, discuss this topic as well. Two studies examined switching to or adding on a DORA in patients being treated with a benzodiazepine receptor agonist. DORAs may be as effective and safe for treating psychiatric comorbid insomnia (for most psychiatric conditions) as they are for treating primary insomnia. However, the evidence is limited to a few small studies. Further investigation of DORAs for the treatment of comorbid insomnia in those with coexisting psychiatric conditions is warranted.

LPS and its relationship with subjective-objective discrepancies of sleep onset latency in patients with psychiatric disorders

Subjective-objective discrepancies in sleep onset latency (SOL), which is often observed among psychiatric patients, is attributed partly to the definition of sleep onset. Recently, instead of SOL, latency to persistent sleep (LPS), which is defined as the duration from turning out the light to the first consecutive minutes of non-wakefulness, has been utilized in pharmacological studies. This study aimed to determine the non-awake time in LPS that is most consistent with subjective sleep onset among patients with psychiatric disorders. We calculated the length of non-awake time in 30-s segments from lights-out to 0.5-60 min. The root mean square error was then calculated to determine the most appropriate length. The analysis of 149 patients with psychiatric disorders showed that the optimal non-awake time in LPS was 12 min. On the other hands, when comorbid with moderate or severe obstructive sleep apnea (OSA), the optimal length was 19.5 min. This study indicates that 12 min should be the best fit for the LPS non-awake time in patients with psychiatric disorders. When there is comorbidity with OSA, however, a longer duration should be considered. Measuring LPS minimizes discrepancies in SOL and provides important clinical information.

The Management of Sleep Disturbances in Patients with Schizophrenia: A Case Series

Patients with schizophrenia commonly encounter a variety of sleep disorders. Disturbed sleep can be found in 30-80% of patients, depending on the degree of psychotic symptomatology. Difficulty falling asleep, maintaining, or achieving restful sleep is associated with symptom severity and has been reported as a prodromal symptom of psychotic relapse. Although some sleep disorders improve with antipsychotic treatment, in many cases, even during disease remission, sleep continues to be fragmented, or even different pathophysiological mechanism is causing sleep disruption. Moreover, it may be complicated if the patient needs specific treatment, such as positive airway pressure (PAP) therapy, due to sleep-disordered breathing. The article presents case reports of patients with schizophrenia with sleep disturbances. As presented in our case reports, cognitive behavioral therapy seems effective in treating comorbid insomnia, even in patients with schizophrenia. The second and third case reports emphasise the need for broader clinical considerations, a cross-diagnostic approach, and cooperation in care for patients with severe mental disorders.

Associations of Depression, Anxiety, and Life Events With the Risk of Obstructive Sleep Apnea Evaluated by Berlin Questionnaire

Background

Psychological problems are prevalent in the general population, and their impacts on sleep health deserve more attention. This study was to examine the associations of OSA risk with depression, anxiety, and life events in a Chinese population.

Methods

A total of 10,287 subjects were selected from the Guangzhou Heart Study. Berlin Questionnaire (BQ) was used to ascertain the OSA. The Center for Epidemiologic Studies Depression Scale (CES-D) and Zung's self-rating anxiety scale (SAS) were used to define depression and anxiety. A self-designed questionnaire was used to assess life events. Odds ratio (OR) with 95% confidence interval (95% CI) was calculated by using the logistic regression model.

Results

There were 1,366 subjects (13.28%) classified into the OSA group. After adjusting for potential confounders, subjects with anxiety (OR: 2.60, 95% CI: 1.63-4.04) and depression (OR: 1.91, 95% CI: 1.19-2.97) were more likely to have OSA. Subjects suffering from both anxiety and depression were associated with a 3.52-fold (95% CI: 1.88-6.31) risk of OSA. Every 1-unit increment of CES-D score and SAS index score was associated with 13% (95% CI: 1.11-1.15) and 4% (95% CI: 1.03-1.06) increased risk of OSA. Neither positive life events nor adverse life events were associated with OSA.

Conclusions

The results indicate that depression and anxiety, especially co-occurrence of both greatly, were associated with an increased risk of OSA. Neither adverse life events nor positive life events were associated with any risk of OSA. Screening for interventions to prevent and manage OSA should pay more attention to depression and anxiety.

A Study of Factors Causing Sleep State Misperception in Patients with Depression

PURPOSE

Sleep state misperception, which is the discrepancy between subjective and objective sleep, is often observed in patients with depression. This phenomenon may delay the remission of depression. Previous studies have focused on the total sleep time (TST) misperception, with many of these studies using actigraphy. Thus, our study investigated depressed patients with the exploratory aim of clarifying factors associated with the sleep state misperception including the wake after sleep onset (WASO) misperception, with their objective sleep additionally evaluated by polysomnography (PSG).

PATIENTS AND METHODS

We conducted a cross-sectional study. Before undergoing overnight PSG monitoring, 40 patients with depression completed questionnaires that included the Beck Depression Inventory (BDI), Epworth sleepiness scale, Temperament and Character Inventory, and the Pittsburgh sleep quality index. Patients were also asked to estimate their subjective sleep duration after they woke up in the morning. Based on this data, we calculated the misperception using the following formula: subjective sleep duration minus objective sleep duration. We compared each factor between negative and positive misperception groups and the multiple regression analysis was performed for TST and WASO misperception, respectively.

RESULTS

Although sleep architectures, age, severity of depression and obstructive sleep apnea (OSA) exhibited differences in underestimating or overestimating the WASO, only sex differences were associated with underestimating or overestimating their total sleep time (TST). Moreover, BDI, the severity of OSA, sleep architectures (N1% and N2%), and benzodiazepine (BZD) use were significantly correlated with WASO misperception, whereas only OSA severity was significantly correlated with TST misperception. A subsequent multiple regression analysis demonstrated the BDI was independently correlated with the WASO misperception (β=0.341, p=0.049).

CONCLUSION

In clinical practice, interventions especially for OSA, and the reduction of depressive symptoms are an important method for improving patient sleep perception. Moreover, current results suggest that BZD prescriptions should be avoided as well.