Comorbidity of Obstructive Sleep Apnea in Psychosomatic Patients Hospitalized in the Luzerner Höhenklinik Montana

Abstract

PURPOSE: The relationship between depression and Obstructive Sleep Apnoea (OSA) has been studied for over twenty years. Ohayon (1) showed that up to 20% of patients with major depression may suffer from OSA. This implies that depressed patients who snore, express fatigue and excessive daytime sleepiness should be evaluated for OSA. In this study our aim was to assess the frequency and management of OSA in in-patients coming to our institution for psychosomatic rehabilitation. METHODS: In a survey of all psychosomatic patients entering our hospital between January 2008 and December 2009, we assessed the co-morbidity of patients with psychosomatic diagnosis and OSA. Screening was done according to clinical suspicion with nocturnal oxymetry and diagnostic assessment either with respiratory polygraphy or polysomnography. After diagnosis of OSA, CPAP treatment was initiated. A further group of patients with known OSA were also identified. RESULTS: Out of a total of 383 patients, 102 were screened with nocturnal oxymetry, respiratory polygraphy (28) or polysomnography (38). Despite high suspicion of OSA in oxymetry, 6 patients refused further diagnostic evaluation due to psychosomatic symptoms.35 patients were identified to have OSA: 14 (40%) had light, 7 (20%) moderate and 14 (40%) severe OSA. 19 were male and 16 female patients. Mean BMI was 30.7 kg/m2, mean age was 59years. 18 had depressive disorders, 6 burn-out, 4 somatisation disorders and 7 various other disorders. Of those with OSA, CPAP was initiated in 16 patients, 3 received other treatment (1 mandibular advancement therapy, 2 forced side position), and 16 refused CPAP. 13 patients were identified, with OSA already diagnosed before admission. CONCLUSION: In 383 psychosomatic patients, 35 (9.1%) had newly diagnosed OSA, and 13 (3.4%) had already known OSA. A total of 48 (12.5%) were found to have OSA. Diagnosis and treatment of OSA can be difficult in psychosomatic patients due to co-morbidities. CLINICAL IMPLICATIONS: Our data support the association between OSA and psychosomatic co-morbidities, and suggest seeking actively for OSA in those patients, especially in those obese patients suffering from depression.