Hostname: page-component-cd9895bd7-mkpzs Total loading time: 0 Render date: 2024-12-26T06:11:28.622Z Has data issue: false hasContentIssue false
  • English
  • Français

Pilot cohort study of obstructive sleep apnoea in community-dwelling people with schizophrenia

Published online by Cambridge University Press:  24 April 2020

H. Myles ,
N. Myles ,
A. D. Vincent ,
G. Wittert ,
R. Adams ,
M. Chandratilleke ,
D. Liu ,
J. Mercer ,
A. Vakulin  and
C. L. Chai-Coetzer
...Show all authors
H. Myles*
Affiliation:
Adelaide Medical School, Adelaide University, 4 North Terrace, Adelaide, South Australia, Australia Northern Adelaide Local Health Network, Adelaide, South Australia, Australia
N. Myles
Affiliation:
The Royal Adelaide Hospital, Port Road, Adelaide, South Australia, Australia
A. D. Vincent
Affiliation:
Adelaide Medical School, Adelaide University, 4 North Terrace, Adelaide, South Australia, Australia Freemasons Foundation Centre for Men’s Health, 254 North Terrace, Adelaide, South Australia, Australia
G. Wittert
Affiliation:
Adelaide Medical School, Adelaide University, 4 North Terrace, Adelaide, South Australia, Australia Freemasons Foundation Centre for Men’s Health, 254 North Terrace, Adelaide, South Australia, Australia
R. Adams
Affiliation:
Adelaide Medical School, Adelaide University, 4 North Terrace, Adelaide, South Australia, Australia The Health Observatory, Discipline of Medicine, 37 Woodville Rd, Woodville South, South Australia, Australia
M. Chandratilleke
Affiliation:
Adelaide Institute for Sleep Health: A Flinders Centre for Research Excellence, Flinders University, Sturt Road, Adelaide, South Australia, Australia
D. Liu
Affiliation:
Adelaide Medical School, Adelaide University, 4 North Terrace, Adelaide, South Australia, Australia Northern Adelaide Local Health Network, Adelaide, South Australia, Australia
J. Mercer
Affiliation:
Adelaide Institute for Sleep Health: A Flinders Centre for Research Excellence, Flinders University, Sturt Road, Adelaide, South Australia, Australia
A. Vakulin
Affiliation:
Adelaide Institute for Sleep Health: A Flinders Centre for Research Excellence, Flinders University, Sturt Road, Adelaide, South Australia, Australia NeuroSleep and Woolcock Institute of Medical Research, University of Sydney, 431 Glebe Point Rd, Glebe, New South Wales, Australia
C. L. Chai-Coetzer
Affiliation:
Adelaide Institute for Sleep Health: A Flinders Centre for Research Excellence, Flinders University, Sturt Road, Adelaide, South Australia, Australia Sleep Health Service, Southern Adelaide Local Health Network, South Australia, Australia
C. Galletly
Affiliation:
Adelaide Medical School, Adelaide University, 4 North Terrace, Adelaide, South Australia, Australia Northern Adelaide Local Health Network, Adelaide, South Australia, Australia Ramsey Health Care (SA) Mental Health, The Adelaide Clinic, 33 Park Tce, Gilberton, South Australia, Australia
*
*Address for correspondence: Dr Hannah Myles, Adelaide Medical School, Adelaide University, 4 North Terrace, Adelaide, South Australia, Australia. (Email: [email protected])
Get access Rights & Permissions [Opens in a new window]

Abstract

Objectives:

We aimed to assess the incidence of obstructive sleep apnoea (OSA) in people with schizophrenia, to explore clinical associates with OSA and how well OSA screening tools perform in this population.

Methods:

All patients registered in a community outpatient Clozapine clinic, between January 2014 and March 2016, were consecutively approached to participate. Participants were screened for OSA using at home multichannel polysomnography (PSG) and were diagnosed with OSA if the apnoea-hypopnoea index (AHI) was >10 events/hr. Univariate comparison of participants to determine whether AHI > 10 events/hr was associated with demographic factors, anthropometric measures and psychiatric symptoms and cognition was performed. The sensitivity, specificity, positive predictive value and negative predictive value of the commonly used sleep symptoms scales and OSA screening tools were also determined.

Results:

Thirty participants were recruited, 24 men and 6 women. Mean age was 38.8 (range: 25–60), and mean body mass index (BMI) was 35.7 (range 19.9–62.1). The proportion of participants with OSA (AHI > 10 events/hr) was 40%, 18 (60%) had no OSA, 4 (13%) had mild OSA (AHI 10.1–20), zero participants had moderate OSA (AHI 20.1–30) and 8 (27%) had severe OSA (AHI > 30). Diagnosis of OSA was significantly associated with increased weight, BMI, neck circumference and systolic blood pressure. Diagnosis of OSA was not significantly associated with Positive and Negative Symptoms Scale, Montgomery Asperger’s Depression Rating Scale, Personal and Social Performance scale or Brief Assessment of Cognition for Schizophrenia scores. All OSA screening tools demonstrated poor sensitivity and specificity for a diagnosis of OSA.

Conclusion:

OSA was highly prevalent in this cohort of people with schizophrenia and was associated with traditional anthropometric OSA risk factors.

Keywords

Clozapineobstructive sleep apnoeaschizophreniasleep apnoea
Type
Original Research
Information
Irish Journal of Psychological Medicine , Volume 38 , Issue 1: Themed Issue: Physical Health in Mental Illness , March 2021 , pp. 23 - 29
Copyright
© College of Psychiatrists of Ireland 2020

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Alam, A, Chengappa, KNR, Ghinassi, F (2012). Screening for obstructive sleep apnea among individuals with severe mental illness at a primary care clinic. General Hospital Psychiatry 34, 660–664.10.1016/j.genhosppsych.2012.06.015CrossRefGoogle Scholar
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (DSM-5®). American Psychiatric Pub.Google Scholar
Anderson, KN, Waton, T, Armstrong, D, Watkinson, HM, Mackin, P (2012). Sleep disordered breathing in community psychiatric patients. European Journal of Psychiatry 26, 86–95.10.4321/S0213-61632012000200002CrossRefGoogle Scholar
Buysse, DJ, Reynolds, CF, Monk, TH, Berman, SR, Kupfer, DJ (1989). The Pittsburgh Sleep Quality Index: a new instrument for psychiatric practice and research. Psychiatry Research 28, 193–213.10.1016/0165-1781(89)90047-4CrossRefGoogle ScholarPubMed
Chai-Coetzer, CL, Antic, NA, Rowland, LS, Catcheside, PG, Esterman, A, Reed, RL, Williams, H, Dunn, S, Mcevoy, RD (2011). A simplified model of screening questionnaire and home monitoring for obstructive sleep apnoea in primary care. Thorax 66, 213–219.10.1136/thx.2010.152801CrossRefGoogle ScholarPubMed
Fett, AK, Viechtbauer, W, Dominguez, MD, Penn, DL, Van Os, J, Krabbendam, L (2011). The relationship between neurocognition and social cognition with functional outcomes in schizophrenia: a meta-analysis. Neuroscience & Biobehavioral Reviews 35, 573–588.10.1016/j.neubiorev.2010.07.001CrossRefGoogle ScholarPubMed
Galletly, CA, Foley, DL, Waterreus, A, Watts, GF, Castle, DJ, Mcgrath, JJ, Mackinnon, A, Morgan, VA (2012). Cardiometabolic risk factors in people with psychotic disorders: the second Australian national survey of psychosis. Australian & New Zealand Journal of Psychiatry 46, 753–761.10.1177/0004867412453089CrossRefGoogle Scholar
Heinzer, R, Vat, S, Marques-Vidal, P, Marti-Soler, H, Andries, D, Tobback, N, Mooser, V, Preisig, M, Malhotra, A, Waeber, G (2015). Prevalence of sleep-disordered breathing in the general population: the HypnoLaus study. The Lancet Respiratory Medicine 3, 310–318.10.1016/S2213-2600(15)00043-0CrossRefGoogle ScholarPubMed
Iber, C, Ancoli-Israel, S, Chesson, A, Quan, SF (2007). The AASM manual for the scoring of sleep and associated events: rules, terminology and technical specifications. American Academy of Sleep Medicine: Westchester, IL.Google Scholar
Johns, MW (1991). A new method for measuring daytime sleepiness: the Epworth sleepiness scale. Sleep 14, 540–545.10.1093/sleep/14.6.540CrossRefGoogle ScholarPubMed
Kay, SR, Fiszbein, A, Opler, LA (1987). The positive and negative syndrome scale (PANSS) for schizophrenia. Schizophrenia Bulletin 13, 261–276.10.1093/schbul/13.2.261CrossRefGoogle Scholar
Keefe, RS, Harvey, PD, Goldberg, TE, Gold, JM, Walker, TM, Kennel, C, Hawkins, K (2008). Norms and standardization of the Brief Assessment of Cognition in Schizophrenia (BACS). Schizophrenia Research 102, 108–115.10.1016/j.schres.2008.03.024CrossRefGoogle Scholar
Laursen, TM, Munk-Olsen, T, Vestergaard, M (2012). Life expectancy and cardiovascular mortality in persons with schizophrenia. Current Opinion in Psychiatry 25, 83–88.10.1097/YCO.0b013e32835035caCrossRefGoogle ScholarPubMed
Matthews, EE, Aloia, MS (2011). Cognitive recovery following positive airway pressure (PAP) in sleep apnea. Progress in Brain Research 190, 71–88.10.1016/B978-0-444-53817-8.00004-9CrossRefGoogle Scholar
Morin, CM, Belleville, G, Belanger, L, Ivers, H (2011). The Insomnia Severity Index: psychometric indicators to detect insomnia cases and evaluate treatment response. Sleep 34, 601–608.10.1093/sleep/34.5.601CrossRefGoogle ScholarPubMed
Morosini, PL, Magliano, L, Brambilla, L, Ugolini, S, Pioli, R (2000). Development, reliability and acceptability of a new version of the DSM-IV Social and Occupational Functioning Assessment Scale (SOFAS) to assess routine social functioning. Acta Psychiatrica Scandinavica 101, 323–329.10.1111/j.1600-0447.2000.tb10933.xCrossRefGoogle ScholarPubMed
Myles, H, Myles, N, Antic, NA, Adams, R, Chandratilleke, M, Liu, D, Mercer, J, Vakulin, A, Vincent, A, Wittert, G (2016). Obstructive sleep apnea and schizophrenia: a systematic review to inform clinical practice. Schizophrenia Research 170, 222–225.CrossRefGoogle ScholarPubMed
Myles, H, Myles, N, Coetzer, CLC, Adams, R, Chandratilleke, M, Liu, D, Mercer, J, Vakulin, A, Vincent, A, Wittert, G, Galletly, C (2019). Cognition in schizophrenia improves with treatment of severe obstructive sleep apnoea: a pilot study. Schizophrenia Research: Cognition 15, 14–20.10.1016/j.scog.2018.09.001CrossRefGoogle ScholarPubMed
Myles, H, Vincent, A, Myles, N, Adams, R, Chandratilleke, M, Liu, D, Mercer, J, Vakulin, A, Wittert, G, Galletly, C (2018). Obstructive sleep apnoea is more prevalent in men with schizophrenia compared to general population controls: results of a matched cohort study. Australas Psychiatry, 1039856218772241.Google ScholarPubMed
Ong, TH, Raudha, S, Fook-Chong, S, Lew, N, Hsu, Aa.L (2010). Simplifying STOP-BANG: use of a simple questionnaire to screen for OSA in an Asian population. Sleep and Breathing 14, 371–376.10.1007/s11325-010-0350-7CrossRefGoogle Scholar
Pan, Y-Y, Deng, Y, Xu, X, Liu, Y-P, Liu, H-G (2015). Effects of continuous positive airway pressure on cognitive deficits in middle-aged patients with obstructive sleep apnea syndrome: a meta-analysis of randomized controlled trials. Chinese Medical Journal 128, 2365.10.4103/0366-6999.163385CrossRefGoogle ScholarPubMed
Patil, SP, Schneider, H, Schwartz, AR, Smith, PL (2007). Adult obstructive sleep apnea: pathophysiology and diagnosis. Chest Journal 132, 325–337.10.1378/chest.07-0040CrossRefGoogle ScholarPubMed
Ruehland, WR, Rochford, PD, O’donoghue, FJ, Pierce, RJ, Singh, P, Thornton, AT (2009). The new AASM criteria for scoring hypopneas: impact on the apnea hypopnea index. Sleep 32, 150–157.10.1093/sleep/32.2.150CrossRefGoogle ScholarPubMed
Sánchez, AI, Martínez, P, Miró, E, Bardwell, WA, Buela-Casal, G (2009). CPAP and behavioral therapies in patients with obstructive sleep apnea: effects on daytime sleepiness, mood, cognitive function. Sleep Medicine Reviews 13, 223–233.10.1016/j.smrv.2008.07.002CrossRefGoogle Scholar
Weaver, TE, Laizner, AM, Evans, LK, Maislin, G, Chugh, DK, Lyon, K, Smith, PL, Schwartz, AR, Redline, S, Pack, AI, Dinges, DF (1997). An instrument to measure functional status outcomes for disorders of excessive sleepiness. Sleep 20, 835–843.Google ScholarPubMed
Williams, JB, Kobak, KA (2008). Development and reliability of a structured interview guide for the Montgomery Asberg Depression Rating Scale (SIGMA). British Journal of Psychiatry 192, 52–58.10.1192/bjp.bp.106.032532CrossRefGoogle Scholar