Selected Papers
Selected papers that are either written by current or former members or by collaborators of the ICMC. Furthermore, we also begin to list papers that we feel might interest you and help you in everyday clinical practice.
Management of hyperglycaemia in persons with non-insulin-dependent type 2 diabetes mellitus who are started on systemic glucocorticoid therapy: a systematic review
Authors: Milos Tatalovic, Roger Lehmann, Marcus Cheetham, Albina Nowak, Edouard Battegay
If you have a suggestion for a paper, feel free to contact one of our staff members.
Guidance
ICMC has prepared a selection of guidance documentation. Please feel free to download and distribute.
If you have a suggestion or would like to request guidance for a specific theme, feel free to contact one of our staff members.
Screening for Sleep Apnea in Patients with Mental Disease or Stroke
Author(s): Edouard Battegay Published on: Sep 06, 2024
This content was generated and slightly amended by ICMC Staff Member Edouard Battegay on September 5th 2024 using ChatGPT4o with the Consensus GPT upon question by a Medical Colleague. Please let us know about potential further contents or errors or whatever: info@multimorbidity.org
Introduction
Sleep apnea encompasses both obstructive sleep apnea syndrome (OSA) and central sleep apnea syndrome (CSA). While OSA is characterized by repeated obstructions of the upper airway, central sleep apnea results from a disruption in respiratory control by the central nervous system. Both forms of sleep apnea are prevalent among patients with psychiatric disorders and stroke patients, significantly impacting health outcomes. This report reviews the available evidence and guidelines to assess whether universal screening for obstructive and central sleep apnea should be recommended for these patient populations.
Evidence from Studies on Patients with Psychiatric Disorders
1. High Prevalence of OSA and CSA in Psychiatric Disorders
Studies show a significant prevalence of OSA in patients with psychiatric disorders, particularly affective disorders such as depression and bipolar disorder. About 62% of psychiatric patients present with OSA, indicating a high risk for untreated sleep apnea [(Wichniak et al., 2023)]. Central sleep apnea is more common in patients with heart failure or neurological conditions, but psychiatric patients, especially those on medications affecting the respiratory center, may also be affected [(Vanek et al., 2022)].
2. Guideline Recommendations for Psychiatric Patients
International guidelines such as those from the American Academy of Sleep Medicine (AASM) recommend that at-risk patients for sleep apnea, including those with psychiatric disorders, be screened for both OSA and CSA. Polysomnography is recommended as the standard diagnostic method, particularly in suspected CSA cases, as home tests may not reliably detect central apneas [(Kapur et al., 2017)]. Patients with psychiatric disorders who experience insomnia, breathing pauses, or excessive daytime sleepiness should be screened for both forms of sleep apnea, especially if they are taking medications that may impair respiration.
3. Conclusion for Psychiatric Patients
Given the high prevalence of OSA and the potential risk for CSA in psychiatric patients, routine screening for both forms of sleep apnea should be considered. Guidelines should aim to standardize these tests across psychiatric clinics.
Evidence from Studies on Stroke Patients
1. OSA and CSA in Stroke Patients
About 60-80% of stroke patients suffer from OSA, which can delay neurological recovery and increase mortality. Central sleep apnea is also prevalent in stroke patients, particularly when brain damage affects respiratory centers [(Camilo et al., 2014)]. CSA is often associated with heart failure but can also occur post-stroke due to damage to the brainstem, which disrupts respiratory regulation. Early diagnosis and treatment of both forms of sleep apnea can improve functional outcomes and survival rates in stroke patients [(Rola et al., 2007)].
2. Guidelines for Stroke Patients
The American Heart Association/American Stroke Association (AHA/ASA) recommends screening for sleep-related breathing disorders (OSA and CSA) in stroke patients, as they are modifiable risk factors for worse neurological outcomes and increased mortality [(Navalkele et al., 2016)]. The Canadian Stroke Prevention Guidelines advocate for the integration of OSA and CSA screening into routine stroke care. This should be done via polysomnography or validated screening tools to detect both OSA and CSA [(King & Cuellar, 2016)].
3. Conclusion for Stroke Patients
Since OSA and CSA are prevalent in stroke patients and lead to poorer recovery and higher mortality if left untreated, all stroke patients should be routinely screened for both forms of sleep apnea.
Recommendations from International and National Guidelines
The American Academy of Sleep Medicine (AASM) recommends thorough screening of at-risk patients with psychiatric disorders or stroke for both OSA and CSA. Polysomnography is recommended for diagnosing CSA as it is the most comprehensive method to detect both obstructive and central apneas [(Kapur et al., 2017)]. The United States Preventive Services Task Force (USPSTF) emphasizes that there is insufficient evidence to recommend universal screening for OSA in asymptomatic adults, but recommends targeted testing for high-risk groups such as stroke patients and patients with severe psychiatric disorders [(Shafazand, 2017)].
Conclusion
Universal screening for OSA and CSA should be recommended for patients with psychiatric disorders and those who have had a stroke. Both forms of sleep apnea are prevalent in these groups and significantly impact health outcomes. International and national guidelines support targeted screening in high-risk patients to ensure early diagnosis and treatment.