title: The high prevalence of obstructive sleep apnea among patients with bipolar disorders.
abstract: BACKGROUND
  Sleep plays an important role in maintaining stability in bipolar disorders, and sleep disturbances can trigger mood episodes. Obstructive sleep apnea (OSA) is a common sleep disorder, yet the co-occurrence with bipolar disorder has not been methodically studied.
  
  
  METHODS
  This is a chart review of 482 consecutively seen patients with a bipolar disorder who underwent routine screening for OSA using a self-report sleep apnea questionnaire. Positive screens were referred for a sleep study.
  
  
  RESULTS
  A positive screen was found in 214 (44.4%) patients. Sleep studies were obtained on 114 patients, and 101, were diagnosed with OSA: point prevalence 21%.
  
  
  CONCLUSIONS
  The 21% prevalence fails to consider the false negative rate of the questionnaire, or the exclusion of patients who screened positive but failed to get a sleep study. Taking these into consideration it is estimated that the true prevalence of OSA in this study may be as high as 47.5%. The co-occurrence of OSA and bipolar disorders is markedly higher than previously thought. Of note, OSA may play a role in refractory bipolar, disorders, and carries significant mortality and morbidity that overlap, with the mortality and morbidity found with bipolar disorders.
  
  
  CONCLUSIONS
  This was a retrospective study based on a self-report questionnaire. Polysomnographic confirmation was performed in only a subgroup of subjects.
  
  
  CONCLUSIONS
  The data suggest that unrecognized OSA may play a major role in the mortality and morbidity of bipolar disorders. All patients diagnosed with a bipolar disorder should be screened with an OSA questionnaire.
authors.affiliation: Depression & Biploar Clinic of Colorado, 400 East Horsetooth Road, Suite 300, Fort Collins, Colorado 80525, USA. TamKelly@comcast.net
authors.forename: Tammas
authors.initials: T
authors.lastname: Kelly
authors.forename: Lanny
authors.initials: L
authors.lastname: Douglas
authors.forename: Lawrence
authors.initials: L
authors.lastname: Denmark
authors.forename: Ginger
authors.initials: G
authors.lastname: Brasuell
authors.forename: Daniel Z
authors.initials: DZ
authors.lastname: Lieberman
mesh_terms: D000328:Adult; D001714:Bipolar Disorder / Q000150:complications*; D015992:Body Mass Index; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D017286:Polysomnography; D015995:Prevalence; D020181:Sleep Apnea, Obstructive / Q000150:complications* / Q000453:epidemiology; D011795:Surveys and Questionnaires
keywords: Bipolar I; Bipolar II; Screening instrument; Sleep apnea; Sleep disorder