The Correlation Between Sleep-Disordered Breathing and Psychiatry

Implications for Practicing Psychiatrists

By Amir Sharafkhaneh, MD, PhD and Max Hirshkowitz, PhD | July 9, 2012

Dr Sharafkhaneh is Associate Professor of Medicine in the Division of Pulmonary, Critical Care, and Sleep Medicine at Baylor College of Medicine, Houston; and the Medical Director of the Sleep Disorders and Research Center at the Section of Pulmonary, Critical Care, and Sleep Medicine, Medical Care Line, Michael E. DeBakey Veterans Affairs Medical Center, Houston. Dr Hirshkowitz is Associate Professor of Medicine in the Division of Pulmonary, Critical Care, and Sleep Medicine at Baylor College of Medicine; Director of Sleep Disorders and Research Center in the Section of Pulmonary, Critical Care, and Sleep Medicine, Medical Care Line, Michael E. DeBakey Veterans Affairs Medical Center; and Associate Professor of Psychiatry in the Menninger Department of Psychiatry, Baylor College of Medicine. The authors report no conflicts of interest concerning the subject matter of this article. Acknowledgment— This work is supported by the Office of Research & Development, Michael E. DeBakey Veterans Affairs Medical Center.

Psychiatric medications

SDB is adversely affected by most sedating medications. Exacerbation of SDB is not restricted to barbiturates, benzodiazepines, and other sleeping pills. Any sedating drug—antidepressant, antipsychotic, analgesic, or antihistamine—can adversely affect breathing during sleep. While these compounds reduce respiratory drive (eg, opioid analgesics), more importantly, they can raise arousal threshold (eg, sedative/hypnotics). If an airway obstruction occurs, ventilation is resumed in response to CNS arousal that allows voluntary dilation of the airway. The more sedated the individual, the more difficult it is to awaken him and the longer it takes to open the airway. Some substances also exacerbate preexisting SDB by compromising muscles responsible for maintaining upper airway patency (eg, benzodiazepines) or allowing the base of the tongue to occlude the airway (eg, alcohol(Drug information on alcohol)).³⁰

Insomnia is a common symptom in many psychiatric disorders and may act synergistically in that sleep loss worsens the overall condition. As such, treatment of insomnia can be critical to managing the psychiatric condition. If the insomnia worsens or if the patient continues having nonrefreshing sleep after a sedative/hypnotic is administered and the duration of sleep is adequate, consider possible SDB. This is especially important if the patient snores, is obese, reports fatigue, or has hypertension. If suspicion is high, a polysomnographic sleep evaluation is indicated.

Summary

Psychiatric comorbid conditions, especially mood disorders and anxiety disorders, are common in patients with SDB. A thorough sleep evaluation is warranted in patients with psychiatric conditions that have SDB risk factors. Screening questionnaires, such as STOP BANG, may help identify persons at risk for SDB. These include middle-aged (or older) postmenopausal women in whom insomnia or snoring has developed, patients who are obese, and patients whose sleep problems worsen when they are taking sedative/hypnotics. An SDB diagnosis, appropriate therapy, and follow-up in these patients may improve management of their comorbid psychiatric conditions.

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by sharon A | July 16, 2012 6:54 PM EDT

Thank you for stressing the implications. In my mid 40's, I had a brief experience with some sleep issues that, I believe, DID provoke significant mood & anxiety issues as a DIRECT RESULT, and I'm realizing I am far from the only one to have experienced that. So, it's good to see that more attention is being drawn to this subject matter.

Also In This Special Report

Introduction: Understanding Common Sleep Disorders in Psychiatric Illness

The Effects of Antidepressants on Sleep

ADHD and Sleep Disorders in Children

The Role of Melatonin in the Circadian Rhythm Sleep-Wake Cycle

The Correlation Between Sleep-Disordered Breathing and Psychiatry

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The Correlation Between Sleep-Disordered Breathing and Psychiatry

Implications for Practicing Psychiatrists

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