Obstructive sleep apnea in psychiatric outpatients. A clinic-based study.
Psychiatric diseases and symptoms are common among patients with obstructive sleep apnea (OSA). However, only a few studies have examined OSA in psychiatric patients. At the outpatient clinic of the Uusikaupunki Psychiatric Hospital, Finland, we used a low referral threshold to a diagnostic sleep study. An ambulatory cardiorespiratory polygraphy was performed in 114 of 221 patients. 95 patients were referred by the psychiatric clinic and 19 were examined in other clinical settings. We reviewed the medical files and retrospectively assessed the prevalence of OSA and the effect of gender, age, obesity, hypertension, type 2 diabetes, alcohol abuse, and symptoms suggesting OSA. 58 of the 221 patients (26.2%), 30 of 85 men (35.3%) and 28 of 136 women (20.6%), had OSA as determined by an apnea-hypopnea index (AHI) of 5/h or more. 20 patients (12 men and 8 women) had moderate or severe OSA (AHI ≥ 15/h). 46 patients (including 11 patients with moderate or severe OSA) were identified in the psychiatric clinic. In univariate analysis, a high body mass index, male gender, hypertension, snoring, and a history of witnessed apneas during sleep were associated with the presence of OSA. In multivariate analysis, a history of witnessed apneas did not remain significant. Age, type 2 diabetes, alcohol abuse, excessive daytime sleepiness (EDS), and fatigue did not associate with the presence of OSA. Our findings suggest that in psychiatric outpatients OSA is common but underdiagnosed. Presentation is often atypical, since many patients with OSA do not report witnessed apneas or EDS.
"Specialists in Psychiatry" Medical Center, Yliopistonkatu 33C28, 20100 Turku, Finland; Department of Psychiatry, Uusikaupunki Psychiatric Hospital, Välskärintie 2, PB 15, 23501 Uusikaupunki, Finland. Electronic address: georgios.nikolakaros@utu.fi.
Georgios
G
Nikolakaros
Department of Clinical Neurophysiology, TYKS-SAPA, Hospital District of Southwest Finland, PB 52, 20521 Turku, Finland. Electronic address: irina.virtanen@tyks.fi.
Irina
I
Virtanen
Turku University Hospital, Neuropsychiatric Outpatient Clinic, PB 52, 20521 Turku, Finland. Electronic address: juha.markkula@tyks.fi.
Juha
J
Markkula
Department of Biostatistics, University of Turku, Lemminkäisenkatu 1, Turun Yliopisto, FI-20014, Finland. Electronic address: tero.vahlberg@utu.fi.
Tero
T
Vahlberg
Division of Medicine, Department of Pulmonary Diseases, Turku University Hospital, PB 52, 20521 Turku, Finland; Sleep Research Centre, Department of Physiology, University of Turku, Lemminkäisenkatu 3B, 20520 Turku, Finland. Electronic address: tarja.saaresranta@tyks.fi.
Tarja
T
Saaresranta
D000328:Adult; D005260:Female; D005387:Finland / Q000453:epidemiology; D006801:Humans; D016015:Logistic Models; D008297:Male; D001523:Mental Disorders / Q000453:epidemiology*; D008875:Middle Aged; D015999:Multivariate Analysis; D010045:Outpatients; D015995:Prevalence; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D020181:Sleep Apnea, Obstructive / Q000175:diagnosis* / Q000453:epidemiology* / Q000503:physiopathology
Cardiorespiratory polygraphy; Obstructive sleep apnea; Psychiatric treatment; Sleep; Sleep disorders