The relationships between obstructive sleep apnea and psychiatricdisorders: a narrative review

Kaja Hanna  Karakuła; Aleksander  Ryczkowski; Elżbieta  Sitarz; Jacek  Januszewski; Dariusz  Juchnowicz

doi:10.2478/cpp-2021-0005

Authors

Kaja Hanna Karakuła Student Research Group at the I Department of Psychiatry, Psychotherapy and Early Intervention,Medical University of Lublin, Poland Author https://orcid.org/0000-0003-1493-8502
Aleksander Ryczkowski Department of Family Medicine, Medical University of Lublin, Poland Author https://orcid.org/0000-0003-2917-0030
Elżbieta Sitarz I Department of Psychiatry, Psychotherapy, and Early Intervention, Medical University of Lublin, Poland Author https://orcid.org/0000-0001-7503-1838
Jacek Januszewski Student Research Group at the Department of Forensic Medicine, Medical University of Lublin, Poland Author https://orcid.org/0000-0003-1023-4081
Dariusz Juchnowicz Department of Psychiatric Nursing, Medical University of Lublin, Poland Author https://orcid.org/0000-0003-2027-5469

DOI:

https://doi.org/10.2478/cpp-2021-0005

Keywords:

Obstructive sleep apnea, OSA, psychiatric disorders

Abstract

Introduction: Obstructive sleep apnea (OSA) is the most common sleep-related breathing disorder. Its prevalence tends to increase worldwide. Untreated sleep apnea is associated with a higher risk of metabolic diseases, cardiovascular diseases, stroke, road accidents, and death, but also it is suggested that it increases the risk of mental disorders.

Method: The literature review was based on a search of articles on Medline, Pubmed, and Google Scholar from 2003 to 2021 using the keywords: obstructive sleep apnea; mental disorders; cognitive functions; affective disorders; depression; bipolar disorder; schizophrenia; psychotic disorders. The analysis included original studies, meta-analysis, and review articles.

Discussion: The result obtained from researches published so far does not allow for drawing unequivocal conclusions. There is a lot of bias present in study protocols and inclusion/exclusion criteria. Nonetheless, it seems that some disorders have a better proven correlation with OSA. Cognitive impairment, depression, and anxiety disorders are linked to OSA not only in terms of the overlapping of symptoms but also of a causal relationship. Psychotic disorders and bipolar disorders connections with OSA are confirmed, but they are not yet well understood. All correlations are found to be possibly bidirectional.

Conclusion:

Multiple lines of evidence increasingly point towards a bidirectional connection between OSA and mental disorders, and the cause and effect relationship between these two groups of disorders requires further research.
Due to reports of an increased risk of OSA with antipsychotic drugs, caution should be exercised when initiating therapy with this type of drug in patients with known risk factors for it.
Screening for OSA in psychiatric patients should be introduced as OSA can increase cognitive impairment, affective, and psychotic symptoms.

References

1. Wiele dowodów wskazuje na dwukierunkowy związek między OBS a zaburzeniami psychicznymi, a związek przyczynowo -skutkowy między tymi dwiema grupami zaburzeń wymaga dalszych badań.

2. Ze względu na doniesienia o zwiększonym ryzyku OBS po zastosowaniu leków przeciwpsychotycznych należy zachować ostrożność rozpoczynając terapię tą grupą leków u pacjentów ze znanymi czynnikami ryzyka OBS.

3. Należy rozważyć wprowadzenie badań przesiewowych w kierunku OBS u pacjentów psychiatrycznych, ponieważ OBS może on nasilać zaburzenia poznawcze, objawy afektywne i psychotyczne.

4. White D.P. Sleep-related breathing disorder: 2- pathophysiology of obstructive sleep apnoea. Thorax, 1995;50:797-804.

5. Qamar A., Qureshi M., Nazar S., Baig S., Iffat W., Owais M. Physical activity and apnoea-hypopnea index in obstructive sleep apnoea. PJP [Internet]. [cited 17 Aug. 2021]; 15(3):67-0. Available from: http://www.pjp.pps.org.pk/index.php/PJP/article/view/1116

6. Healthysleep.med.harvard.edu [home page on the Internet]. Understanding the Results; 2011 [updated Feb 11, 2011; cited Sep 7, 2021]. Accessible at: https://healthysleep.med.harvard.edu/sleep-apnea/diagnosing-osa/understanding-results

7. Rundo J.V. Obstructive sleep apnea basics. Cleve Clin J Med. 2019;86:2-9.

8. Heinzer R., Vat S., Marques-Vidal P., Marti-Soler H., Andries D., Tobback N., et al. Prevalence of sleep-disordered breathing in the general population: the HypnoLaus study. Lancet Respir Med. 2015;3(4):310-8.

9. Al Lawati N.M., Patel S.R., Ayas N.T. Epidemiology, risk factors, and consequences of obstructive sleep apnea and short sleep duration. Prog Cardiovasc Dis. 2009;51(4):285-93.

10. Franklin K.A., Lindberg E. Obstructive sleep apnea is a common disorder in the population-a review on the epidemiology of sleep apnea. J Thorac Dis. 2015;7(8):1311-22.

11. Tufik S., Santos-Silva R., Taddei J.A., Bittencourt L.R. Obstructive sleep apnea syndrome in the Sao Paulo Epidemiologic Sleep Study. Sleep Med. 2010;11(5):441-6.

12. Young T., Peppard P.E., Gottlieb D.J. Epidemiology of obstructive sleep apnea: a population health perspective. Am. J. Respir. Crit. Care Med. 2002;165:1217-1239.

13. Reuveni H., Tarasiuk A., Wainstock T., Ziv A., Elhayany A., Tal A. Awareness level of obstructive sleep apnea syndrome during routine unstructured interviews of a standardized patient by primary care physicians. Sleep 2004;27:1518-1525.

14. Kapur V., Strohl K.P., Redline S., Iber C., O’Connor G., Nieto J. Underdiagnosis of sleep apnea syndrome in U.S. communities. Sleep Breath. 2002;6:49-5.

15. Punjabi N.M., Polotsky V.Y. Disorders of glucose metabolism in sleep apnea. J Appl Physiol (1985) 2005;99:1998-2007.

16. Knauert M., Naik S., Gillespie M.B., Kryger M. Clinical consequences and economic costs of untreated obstructive sleep apnea syndrome. World J Otorhinolaryngol Head Neck Surg. 2015;1(1):17-27.

17. Faber J., Faber C., Faber A.P. Obstructive sleep apnea in adults. Dental Press J Orthod. 2019;24(3):99-109.

18. Gupta M.A., Simpson F.C. Obstructive sleep apnea and psychiatric disorders: a systematic review. J Clin Sleep Med. 2015;11(2):165-175.

19. Harris M., Glozier N., Ratnavadivel R., Grunstein R.R. Obstructive sleep apnea and depression. Sleep Med Rev. 2009;13(6):437-44.

20. Grigg-Damberger M., Ralls F. Cognitive dysfunction and obstructive sleep apnea: from cradle to tomb. Curr Opin Pulm Med. 2012;18(6):580-7.

21. Vanek J., Prasko J., Genzor S., Ociskova M., Kantor K., Holubova M., et al. Obstructive sleep apnea, depression and cognitive impairment. Sleep Med. 2020;72:50-58.

22. Sharafkhaneh A., Giray N., Richardson P., Young T., Hirshkowitz M. Association of psychiatric disorders and sleep apnea in a large cohort. Sleep. 2005;28(11):1405-11.

23. Mellman T.A. In Psychiatric Clinics of North America. Sleep Med Clin. 2008;3(2):261-268.

24. Lee M.H., Lee S.A., Lee G.H., Ryu H.S., Chung S., Chung Y.S., et al. Gender differences in the effect of comorbid insomnia symptom on depression, anxiety, fatigue, and daytime sleepiness in patients with obstructive sleep apnea. Sleep Breath. 2014;18(1):111-7.

25. Karkoulias K., Lykouras D., Sampsonas F., Karaivazoglou K., Sargianou M, Drakatos P, et al. The impact of obstructive sleep apnea syndrome severity on physical performance and mental health. The use of SF-36 questionnaire in sleep apnea. Eur Rev Med Pharmacol Sci. 2013;17(4):531-6.

26. Rezaeitalab F., Moharrari F., Saberi S., Asadpour H., Rezaeetalab F. The correlation of anxiety and depression with obstructive sleep apnea syndrome. J Res Med Sci. 2014;19(3):205-10.

27. Kaufmann C.N., Susukida R., Depp C.A. Sleep apnea, psychopathology, and mental health care. Sleep Health. 2017;3(4):244-249.

28. Guilleminault C., Tilkian A., Dement W.C. The sleep apnea syndromes. Annu Rev Med. 1976;27:465-84.

29. Knechtle B., Economou N.-T., Nikolaidis P.T., Velentza L., Kallianos A., Steiropoulos P., et al. Clinical Characteristics of Obstructive Sleep Apnea in Psychiatric Disease. Journal of Clinical Medicine. 2019; 8(4):534.

30. Ferini-Strambi L., Baietto C., Di Gioia M.R., Castaldi P., Castronovo C., Zucconi M, et al. Cognitive dysfunction in patients with obstructive sleep apnea (OSA): partial reversibility after continuous positive airway pressure (CPAP). Brain Res Bull 2003;61:87-92.

31. Stranks E.K., Crowe S.F. The Cognitive Effects of Obstructive Sleep Apnea: An Updated Meta-analysis. Arch Clin Neuropsychol. 2016;31(2):186-93.

32. Gutiérrez Iglesias B., Jacas Escarceller C., Bardés Robles I., Cambrodi Masip R., Romero Santo-Tomás O., Pujadas Navinés F., et al. Effectiveness of 6-months continuous positive airway pressure treactment in OSAS-related cognitive deficit in older adults. Behav Neurol. 2013;26(3):191-4.

33. Olaithe M., Bucks R.S., Hillman D.R., Eastwood P.R. Cognitive deficits in obstructive sleep apnea: Insights from a meta-review and comparison with deficits observed in COPD, insomnia, and sleep deprivation. Sleep Med Rev. 2018;38:39-49.

34. Beaudin A.E., Raneri J.K., Ayas N.T., Skomro R.P., Fox N., Hirsch Allen A.J.M., et al. Cognitive Function in a Sleep Clinic Cohort of Patients with Obstructive Sleep Apnea. Ann Am Thorac Soc. 2021;18(5):865-875.

35. Mubashir T., Abrahamyan L., Niazi A., Piyasena D., Arif A.A., Wong J., et al. The prevalence of obstructive sleep apnea in mild cognitive impairment: a systematic review. BMC Neurol. 2019;19(1):195.

36. Taylor H.G., Bowen S.R., Beebe D.W., Hodges E., Amin R., Arens R., et al. Cognitive Effects of Adenotonsillectomy for Obstructive Sleep Apnea. Pediatrics. 2016;138(2):e20154458.

37. Yusop C.Y.C., Mohamad I., Mohammad W.M.Z.W., Abdullah B. Cognitive Function Among Obstructive Sleep Apnea Patients in North East Malaysia. J Natl Med Assoc. 2017;109(3):215-220.

38. Bilyukov R.G., Nikolov M.S., Pencheva V.P., Petrova D.S., Georgiev O.B., Mondeshki T.L., et al. Cognitive Impairment and Affective Disorders in Patients with Obstructive Sleep Apnea Syndrome. Front Psychiatry. 2018;9:357.

39. Mu L., Peng L., Zhang Z., Jie J., Jia S., Yuan H. Memory and Executive Screening for the Detection of Cognitive Impairment in Obstructive Sleep Apnea. Am J Med Sci. 2017;354(4):399-407.

40. Castronovo V., Scifo P., Castellano A., Aloia M.S., Iadanza A., Marelli S., et al. White matter integrity in obstructive sleep apnea before and after treatment. Sleep. 2014;37(9):1465-75.

41. Ceïde M.E., Williams N.J., Seixas A., Longman-Mills S.K., Jean-Louis G. Obstructive sleep apnea risk and psychological health among non-Hispanic blacks in the Metabolic Syndrome Outcome (MetSO) cohort study. Ann Med. 2015;47(8):687-93.

42. Saunamäki T., Jehkonen M. Depression and anxiety in obstructive sleep apnea syndrome: a review. Acta Neurol Scand. 2007;116(5):277-88.

43. Garbarino S., Bardwell W.A, Guglielmi O., Chiorri C., Bonanni E., Magnavita N. Association of Anxiety and Depression in Obstructive Sleep Apnea Patients: A Systematic Review and Meta-Analysis. Behav Sleep Med. 2020;18(1):35-57.

44. Gupta M.A., Simpson F.C., Lyons D.C. The effect of treating obstructive sleep apnea with positive airway pressure on depression and other subjective symptoms: A systematic review and meta-analysis. Sleep Med Rev. 2016; 28:55-68.

45. Lehto S.M., Sahlman J., Soini E.J., Gylling H., Vanninen E., Seppä J., et al. The association between anxiety and the degree of illness in mild obstructive sleep apnoea. Clin Respir J. 2013;7(2):197¬203.

46. O’Donovan A., Hughes B.M., Slavich G.M., Lynch L., Cronin M.T., O’Farrelly C., et al. Clinical anxiety, cortisol and interleukin-6: evidence for specificity in emotion-biology relationships. Brain Behav Immun. 2010;24:1074-7.

47. Sahlman J., Miettinen K., Peuhkurinen K., Seppä J., Peltonen M., Herder C., et al. The activation of the inflammatory cytokines in overweight patients with mild obstructive sleep apnoea. J Sleep Res. 2010;19(2):341-8.

48. Narita K., Murata T., Hamada T., Takahashi T., Omori M., Suganuma N., et al. Interactions among higher trait anxiety, sympathetic activity, and endothelial function in the elderly. J Psychiatr Res. 2007;41:418-27.

49. Diaz S.V., Brown L.K. Relationships between obstructive sleep apnea and anxiety. Curr Opin Pulm Med. 2016;22(6):563-9.

50. Sweetman A., Lack L., McEvoy R.D., Catcheside P.G., Antic N.A., Chai-Coetzer C.L., et al. Effect of depression, anxiety, and stress symptoms on response to cognitive behavioral therapy for insomnia in patients with comorbid insomnia and sleep apnea: a randomized controlled trial. J Clin Sleep Med. 202;17(3):545-554.

51. Peppard P.E., Szklo-Coxe M., Hla K.M., Young T. Longitudinal association of Sleep-Related Breathing Disorder and Depression. Arch Intern Med. 2006;166(16):1709-1715.

52. Wheaton A.G., Perry G.S., Chapman D.P., Croft J.B. Sleep disordered breathing and depression among U.S. adults: National Health and Nutrition Examination Survey, 2005-2008. Sleep. 2012;35(4):461-7.

53. BaHammam A.S., Kendzerska T., Gupta R., Ramasubramanian C., Neubauer D.N., Narasimhan M., et al. Comorbid depression in obstructive sleep apnea: an under-recognized association. Sleep Breath. 2016;20(2):447-56.

54. Ohayon M.M. The effects of breathing-related sleep disorders on mood disturbances in the general population. J Clin Psychiatry. 2003;64(10):1195-200.

55. Chen Y.H., Keller J.K., Kang J.H., Hsieh H.J., Lin H.C. Obstructive sleep apnea and the subsequent risk of depressive disorder: a population-based follow-up study. J Clin Sleep Med. 2013;9(5):417-23.

56. Andrade L., Caraveo-Anduaga J.J., Berglund P., Bijl R.V., De Graaf R., Vollebergh W., et al. The epidemiology of major depressive episodes: results from the International Consortium of Psychiatric Epidemiology (ICPE) Surveys. Int J Methods Psychiatr Res. 2003;12(1):3-21.

57. El-Sherbini A.M., Bediwy A.S., El-Mitwalli A. Association between obstructive sleep apnea (OSA) and depression and the effect of continuous positive airway pressure (CPAP) treatment. Neuropsychiatr Dis Treat. 2011;7:715-21.

58. Jackson M.L., Tolson J., Bartlett D., Berlowitz D.J., Varma P., Barnes M. Clinical depression in untreated obstructive sleep apnea: examining predictors and a meta-analysis of prevalence rates. Sleep Med. 2019;62:22-28.

59. Eldahdouh S.S., El-Habashy M.M., Elbahy M.S. Effect of CPAP on depressive symptoms in OSA. Egypt J Chest Dis Tuberc. 2014;63(2):389e93.

60. Martínez-García M.Á., Chiner E., Hernández L., Cortes J.P., Catalán P., Ponce S., et al.; Spanish Sleep Network. Obstructive sleep apnoea in the elderly: role of continuous positive airway pressure treatment. Eur Respir J. 2015;46(1):142-51.

61. Lee I.S., Bardwell W., Ancoli-Israel S., Loredo J.S., Dimsdale J.E. Effect of three weeks of continuous positive airway pressure treatment on mood in patients with obstructive sleep apnoea: a randomized placebo-controlled study. Sleep Med. 2012;13(2):161-6.

62. Hobzova M., Prasko J., Vanek J., Ociskova M., Genzor S., Holubova M., et al. Depression and obstructive sleep apnea. Neuro endocrinology letters. 2017;38:343-352.

63. Frangopoulos F., Zannetos S., Nicolaou I., Economou N.T., Adamide T., Georgiou A., et al. The Complex Interaction Between the Major Sleep Symptoms, the Severity of Obstructive Sleep Apnea, and Sleep Quality. Front Psychiatry. 2021;12:630162.

64. Means M.K., Lichstein K.L., Edinger J.D., Taylor D.J., Durrence H.H., Husain A.M., et al. Changes in depressive symptoms after continuous positive airway pressure treatment for obstructive sleep apnea. Sleep Breath. 2003;7(1):31-42.

65. van Wyk M., McCreesh-Toselli S., Williams S., O Ebrahim I. The distinct roles of OSA and depression severity in day-and night¬time symptomatology in OSA patients: a pilot study. Sleep Breath. 2020;24(3):931-939.

66. Edwards C., Almeida O.P., Ford A.H. Obstructive sleep apnea and depression: A systematic review and meta-analysis. Maturitas. 2020;142:45-54.

67. Myles H., Myles N., Antic N.A., Adams R., Chandratilleke M., Liu D., et al. Obstructive sleep apnea and schizophrenia: A systematic review to inform clinical practice. Schizophr Res. 2016;170(1):222-5.

68. Stubbs B., Vancampfort D., Veronese N., Solmi M., Gaughran F., Manu P., et al. The prevalence and predictors of obstructive sleep apnea in major depressive disorder, bipolar disorder and schizophrenia: A systematic review and meta-analysis. J Affect Disord. 2016;197:259-67.

69. Kalucy M.J., Grunstein R., Lambert T., Glozier N. Obstructive sleep apnoea and schizophrenia--a research agenda. Sleep Med Rev. 2013;17(5):357-65.

70. Alam A., Chengappa K.N., Ghinassi F. Screening for obstructive sleep apnea among individuals with severe mental illness at a primary care clinic. Gen Hosp Psychiatry. 2012;34(6):660-4.

71. Kaskie R.E., Graziano B., Ferrarelli F. Schizophrenia and sleep disorders: links, risks, and management challenges. Nat Sci Sleep. 2017;9:227-239.

72. Boufidis S., Kosmidis M.H., Bozikas V.P., Skalopoulou-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.

73. Szaulińska K., Pływaczewski R., Sikorska O., Holka-Pokorska J., Wierzbicka A., Wichniak A., et al. Obstructive sleep apnea in severe mental disorders. Psychiatr Pol. 2015;49(5):883-95.

74. Seeman M.V. Diagnosis and treatment of sleep apnoea in women with schizophrenia. J Ment Health. 2014;23(4):191-6.

75. Darwish M., Bond M., Yang R., Hellriegel E.T., Robertson P. Evaluation of potential pharmacokinetic drug-drug interaction between armodafinil and risperidone in healthy adults. Clin Drug Investig. 2015;35(11):725-33.

76. Rishi M.A., Shetty M., Wolff A., Amoateng-Adjepong Y., Manthous C.A. Atypical antipsychotic medications are independently associated with severe obstructive sleep apnea. Clin Neuropharmacol. 2010;33(3):109-13.

77. Anderson K.N., Waton T., Armstrong D., Watkinson H.M., Mackin P. Sleep disordered breathing in community psychiatric patients. Eur. J. Psychiat. 2012;26(2):86-95.

78. Joo E.Y., Tae W.S., Lee M.J., Kang J.W., Park H.S., Lee J.Y., et al. Reduced brain gray matter concentration in patients with obstructive sleep apnea syndrome. Sleep. 2010;33(2):235-41.

79. Schröder C.M., O'Hara R. Depression and Obstructive Sleep Apnea (OSA). Ann Gen Psychiatry. 2005;4:13.

80. Plante D.T., Winkelman J.W. Sleep disturbance in bipolar disorder: therapeutic implications. Am J Psychiatry. 2008;165:830-43.

81. Aggarwal R., Baweja R., Saunders E.F., Singareddy R. CPAP-induced mania in bipolar disorder: a case report. Bipolar Disord. 2013;15(7):803-807.

82. Thompson W.K., Kupfer D.J., Fagiolini A., Scott J.A., Frank E. Prevalence and clinical correlates of medical comorbidities in patients with bipolar I disorder: analysis of acute-phase data from a randomized controlled trial. J Clin Psychiatry. 2006;67(5):783-8.

83. Chengappa K.N., Suppes T., Berk M. Treatment of bipolar mania with atypical antipsychotics. Expert Rev Neurother. 2004;4:17-S25.

84. Sériès F., Roy N., Marc I. Effects of sleep deprivation and sleep fragmentation on upper airway collapsibility in normal subjects. Am J Respir Crit Care Med. 1994;150(2):481-5.

85. Gozal D., Row B.W., Gozal E., Kheirandish L., Neville J.J., Brittian K.R., et al. Temporal aspects of spatial task performance during intermittent hypoxia in the rat: evidence for neurogenesis. Eur J Neurosci. 2003;18(8):2335-42.

86. Canessa N., Castronovo V., Cappa S.F., Aloia M.S., Marelli S., Falini A., et al. Obstructive sleep apnea: brain structural changes and neurocognitive function before and after treatment. Am J Respir Crit Care Med. 2011;183(10):1419-26.

87. Lopresti A.L., Drummond P.D. Obesity and psychiatric disorders: commonalities in dysregulated biological pathways and their implications for treatment. Prog Neuropsychopharmacol Biol Psychiatry. 2013;45:92-9.

The relationships between obstructive sleep apnea and psychiatricdisorders: a narrative review

Authors

DOI:

Keywords:

Abstract

References

Downloads

Published

Issue

Section

License

sidebar

Language