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).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.
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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