Aggarwal Richa, Baweja Raman, Saunders Erika Fh, Singareddy Ravi
Department of Psychiatry, Penn State Milton S. Hershey Medical Center, Hershey, PA, USA.
Bipolar Disord. 2013 Nov;15(7):803-7. doi: 10.1111/bdi.12112. Epub 2013 Aug 27.
In this case report we present our clinical observations of two patients with bipolar disorder with comorbid obstructive sleep apnea (OSA) who were treated with continuous positive airway pressure (CPAP) for their sleep apnea.
Bipolar disorder is a psychiatric disorder characterized by the presence of one or more episodes of mania and frequent episodes of depression. This disorder affects approximately 0.8% of the adult population, with estimates from community samples ranging between 0.4% and 1.6%. OSA syndrome is a severe sleep disorder with a prevalence of 2-4% in the general population, the risk of which is increased by obesity. The prevalence of OSA is expected to be high in bipolar disorder due to high comorbid obesity. It is expected that improvement in OSA in patients with bipolar disorder with CPAP will improve mood and other symptoms of bipolar disorder. However, there is a relative lack of data examining this aspect.
In both cases of bipolar disorder, CPAP was started after a polysomnographic diagnosis of OSA and CPAP titration study indicating that most of the apneas/hypopneas were eliminated with a significant improvement in oxygen saturation. To our surprise, we noted that in both of these cases initiation of CPAP resulted in manic symptoms.
Clinicians need to monitor patients with bipolar disorder closely for worsening of manic symptoms when they are started on CPAP for underlying OSA.
在本病例报告中，我们展示了对两名患有双相情感障碍合并阻塞性睡眠呼吸暂停（OSA）患者的临床观察，他们接受了持续气道正压通气（CPAP）治疗睡眠呼吸暂停。
双相情感障碍是一种精神疾病，其特征为存在一次或多次躁狂发作以及频繁的抑郁发作。这种疾病影响约0.8%的成年人口，社区样本估计范围在0.4%至1.6%之间。OSA综合征是一种严重的睡眠障碍，在普通人群中的患病率为2 - 4%，肥胖会增加其风险。由于双相情感障碍患者中肥胖合并症的发生率较高，预计OSA在双相情感障碍患者中的患病率也较高。预计使用CPAP治疗双相情感障碍合并OSA患者的OSA改善后，将改善双相情感障碍的情绪和其他症状。然而，在这方面相对缺乏相关数据研究。
在这两例双相情感障碍病例中，在多导睡眠图诊断为OSA且CPAP滴定研究表明大多数呼吸暂停/低通气被消除且氧饱和度有显著改善后开始使用CPAP。令我们惊讶的是，我们注意到在这两例病例中，开始使用CPAP均导致了躁狂症状。
临床医生在为患有潜在OSA的双相情感障碍患者开始使用CPAP时，需要密切监测患者躁狂症状的恶化情况。
