Psychiatry - August 2008 - (Page 48)

[REVIEW] Obstructive Sleep Apnea, Hypoxia, and Metabolic Syndrome in Psychiatric and Nonpsychiatric Settings by ATMARAM YARLAGADDA, MD; SHAIFALI KAUSHIK, MD; and ANITA H. CLAYTON, MD Dr. Yarlagadda is from Newport News, Virginia; Dr. Kaushik is with Shields Healthcare Group in Stockton, Massachusetts; and Dr. Clayton is Professor, Department of Psychiatry and Neurobehavioral Sciences, University of Virginia, Charlottesville, Virginia. Psychiatry (Edgemont) 2008;5(8):48–50 ABSTRACT Obesity continues to be a serious cause of morbidity and mortality globally and particularly in North America. Primary manifestations of obesity include obstructive sleep apnea (OSA) and depression associated with a decrease in immune defense mechanisms, possibly related to increased cytokine levels. Secondary manisfestations of obesity possibly result from a cascade of events and include insulin resistance/ hyperglycemia, hyperlipidemia, and hypertension—all of which comprise metabolic syndrome. This paper reviews sleep disturbances in general and OSA in psychiatric patients, particularly those who are obese. BACKGROUND Although sleep disturbance is a common symptom of major depression, it is frequently underrecognized, particularly in psychiatric patient samples.1 Although it is clear that normalizing the architecture of sleep is predictive of depression treatment,2 the incidence of obstructive sleep apnea (OSA) in the psychiatric population appears to be rising. As an entity, OSA appears to occur more commonly in neuropsychiatric conditions than with other medical conditions.3,4 This risk appears to be bidirectional, with obesity 48 Psychiatry 2008 [ A U G U S T ] ADDRESS CORRESPONDENCE TO: Atmaram Yarlagadda, MD, E-mail: atma@golfolks.com KEY WORDS: obstructive sleep apnea, hypoxia, metabolic syndrome, psychiatric illness contributing to airway obstruction during sleep and psychiatric illness and its treatment being associated with weight gain.5 Exploring the association between psychiatric illnesses, obesity, and OSA could help define the treatment strategies relevant to individual cases as opposed to generic treatment directed toward symptom relief. PRIMARY MANIFESTATION/ OBSTRUCTIVE SLEEP APNEA OSA is the most common breathing-related sleep disorder, making up 40 to 50 percent of sleep disorder diagnoses. By definition, OSA is a cluster of frequent breathless episodes (apneic) lasting seconds to minutes during sleep as a result of airway obstruction. Sleep

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Psychiatry - August 2008 Editor’s Message Editorial Advisory Board Contents Borderline Personality Disorder: Are Proliferative Symptoms Characteristic? Short-acting versus Long-acting Medications for the Treatment of ADHD Baby Stimuli and the Parent Brain: Functional Neuroimaging of the Neural Substrates of Parent-Infant Attachment These Boots Are Made for Stalking: Characteristics of Female Stalkers Managing Attention Deficit Hyperactivity Disorder in the Emergency Department Obstructive Sleep Apnea, Hypoxia, and Metabolic Syndrome in Psychiatric and Nonpsychiatric Settings Improving the Quality of Life in Patients with Alzheimer’s Disease The Process of Getting New Drugs to Market Journal Watch Classified Advertising Information for Authors

Psychiatry - August 2008

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