title: Screening for obstructive sleep apnea in patients with bipolar I disorder: comparison between subjective and objective measures.
abstract: OBJECTIVE
  Many of the first-line screening tools for obstructive sleep apnea (OSA) may not be accurate in patients with bipolar disorder due to confounding factors, such as chronic depressive symptoms, weight gain, and sedation due to medications. In the present study, we assessed the feasibility of in-home screening for sleep apnea in patients with bipolar disorder and assessed the validity of a screening questionnaire versus an objective measure of apnea-hypopnea index (AHI).
  
  
  METHODS
  A total of 28 subjects with bipolar I disorder (19 females,and nine males; mean age 41.7 ± 9.8 years) completed the Berlin Questionnaire for sleep apnea screening and their AHI was objectively measured with a portable in-home device.
  
  
  RESULTS
  Eleven subjects (39%) had an AHI ≥ 5. The Berlin Questionnaire showed a poor positive and negative predictive value for identifying sleep apnea in patients with bipolar disorder.
  
  
  CONCLUSIONS
  While OSA may be relatively prevalent among patients with bipolar disorder, self-report screening tools used in clinical practice may be highly inaccurate for this population. In-home screening with a patient-operated monitoring device may be a valid and feasible alternative for patients with bipolar disorder.
authors.affiliation: Department of Psychiatry, Western Psychiatric Institute and Clinic, University of Pittsburgh Medical Center, Pittsburgh, PA, USA.
authors.forename: Isabella
authors.initials: I
authors.lastname: Soreca
authors.forename: Joan A
authors.initials: JA
authors.lastname: Buttenfield
authors.forename: Martica H
authors.initials: MH
authors.lastname: Hall
authors.forename: David J
authors.initials: DJ
authors.lastname: Kupfer
mesh_terms: D000328:Adult; D001714:Bipolar Disorder / Q000150:complications / Q000523:psychology*; D015331:Cohort Studies; D003863:Depression / Q000523:psychology*; D005260:Female; D006801:Humans; D008297:Male; D008403:Mass Screening / Q000379:methods; D008875:Middle Aged; D017286:Polysomnography; D015995:Prevalence; D012680:Sensitivity and Specificity; D020181:Sleep Apnea, Obstructive / Q000150:complications / Q000175:diagnosis* / Q000523:psychology; D011795:Surveys and Questionnaires
keywords: bipolar disorder; cardiovascular risk; portable screening device; sleep apnea