Psychiatric Sequalae of Sleep Disorders .


21 views
Uploaded on:
Category: Product / Service
Description
Psychiatric Sequalae of Sleep Disorders. Mark Brown, M.D. Stanford Sleep Disorders Center A.W.A.K.E. Meeting. Introduction Primary Sleep Disorders  Psychiatry Summary. Presentation Overview. Epidemiology Common Psychiatric Morbidity Sleep and Psychiatry Comorbid
Transcripts
Slide 1

Psychiatric Sequalae of Sleep Disorders Mark Brown, M.D. Stanford Sleep Disorders Center A.W.A.K.E. Meeting

Slide 2

Introduction Primary Sleep Disorders  Psychiatry Summary Presentation Overview

Slide 3

Epidemiology Common Psychiatric Morbidity Sleep and Psychiatry Comorbid Difficult to separate Etiology, result, or both? Presentation

Slide 4

Insufficient Sleep Fragmenting Disorders SDB RLS/PLMD Disorders of Hypersomnolence Narcolepsy Primary Sleep Disorders

Slide 5

Very regular in today " s society 20% of 1.1 million Americans rest under 6.5 hrs/night Basal Sleep Need Epi ponders demonstrate mean need of 8.16 hrs/night Insufficient Sleep Principles and Practice of Sleep Medicine, 4 th Ed. 2005

Slide 6

Neuropsychiatric Effects Cognitive, psychomotor, memory Subjective versus Objective Insufficient Sleep Balkin et al. Rest Loss and Sleepiness. Mid-section. 134(3):653-660, 2008 Sep.

Slide 7

Individual contrasts Stable inside people Varies between people Need versus Versatility? Inadequate Sleep Van Dongen et al. " The total cost of extra attentiveness: dosage reaction consequences for neurobehavioral capacities and rest physiology from interminable rest limitation and aggregate lack of sleep. " Sleep. 2003 Mar 15;26(2):117-26.

Slide 8

Obstructive Sleep Apnea/Hypopnea Syndrome (OSAHS) Apnea/Hypopnea Index (AHI) <5 ordinary 5-15 gentle 15-30 direct >30 extreme Common OSA: 4% of men and 2% of ladies Screening Symptoms Snoring Witnessed apneas Choking feelings of excitement Spouse report Signs BMI Neck Circumference HTN Sleep Disordered Breathing (SDB)

Slide 9

Multiple Studies Guilleminault et al Reynolds et al Millmann et al Mosko, S et al Aikens et al SDB and Depression Schroder et al. Misery and Obstructive Sleep Apnea (OSA). Records of General Psychiatry 2005, 4:13, 1-8.

Slide 10

Review Harris et al Large commonness concentrates on Sleep-EVAL VA database Hordaland Health Study Correlational studies Cross-sectional studies Prospective longitudinal Studies Peppard et al Treatment contemplates SDB and Depression Harris et al. Clinical Review: Obstructive rest apnea and discouragement. Rest Medicine Reviews 13 (2009) 437-444.

Slide 11

Review 1995-2006 OSA and Depression/Anxiety 203 aggregate articles Rigorous avoidance criteria Final aggregate of 55 articles Results Age 44-69 yrs Median N 54 Median male sex 83% Median AHI 48 Assessment of Mood Beck, Zung, CES-D, HADS, STAI, POMS, MMPI, SCL-90, SCID, meet, and so forth … SDB and Depression Saunamaki T, Jehkonen M. Sadness and uneasiness in obstructive rest apnea disorder: an audit. Acta Neurol Scand 2007:116:277-288.

Slide 12

Pretreatment Prevalence Depression 7-63% Anxiety 11-70% CPAP Treatment 7 thorough studies Depression diminished in 4/7 contemplates Anxiety diminished in 2/4 considers SDB and Depression (cont) Saunamaki T, Jehkonen M. Discouragement and nervousness in obstructive rest apnea disorder: an audit. Acta Neurol Scand 2007:116:277-288.

Slide 13

Sleep Heart Health Study (SHHS) 6,441  3,078 subjects 2 PSG " s, 5 yrs separated Quality of Life Mental Component Summary Scale (MCS) Sample Age 62 55% female 75% Caucasian Results Very little changes more than 5 years in RDI, BMI, ESS, PCS, and MCS. Insignificant change in PCS and no adjustment in MCS Significant relationship between subjective rest quality and PCS/MCS. Not clinically critical changes more than 5 years SDB and Depression Silva et al, Sleep Disordered Breathing and Quality of Life. Rest , 32(8), 1049-1057.

Slide 14

Review Aloia et al 1985-2002 Initial 187 articles Final examination 37 articles Limitations Results Impairment > 60% Attention/Vigilance Exec Functioning Memory Impairment >80% Construction Motor Functioning SDB and Cognitive Dysfunction Aloia et al. Neuropsychological sequelae of obstructive rest apnea-hypopnea disorder: A Critical Review. JINS, 2004, 10, 772-785.

Slide 15

Treatment Attention/watchfulness (11/17) Global working, official working, and memory (6/10, 7/15, 8/15) Psychomotor working neglected to enhance (0/6) SDB and Cognitive Dysfunction (cont) Aloia et al. Neuropsychological sequelae of obstructive rest apnea-hypopnea disorder: A Critical Review. JINS, 2004, 10, 772-785.

Slide 16

Introduction ADHD comorbidity Prospective Study Adenotonsillectomy (AT) companion and surgical control N=78, 5-12.9(8.4)yrs Mild-Moderate seriousness 57% male 95% f/u rate Measurements Results AT gathering Higher scores for hyperactivity, absentmindedness, MSLT, and ADHD at standard and enhanced to control rate 1 yr after surgery However, just drowsiness related with PSG SDB in Children Chervin et al. Rest disarranged breathing, conduct, and comprehension in youngsters previously, then after the fact adenotonsillectomy. Pediatrics. 117(4) 2006 e769-e778.

Slide 17

Complex relationship 20+ year history of studies Comorbid Treatment suggestions Lack of reaction ADHD cover in kids SDB Summary

Slide 18

RLS Definition/Criteria " Unpleasant " Limb Sensations Motor Restlessness Precipitated by REST and Relieved by Activity Worse in Evening/Night PLMD Definition/Criteria Repetitive, stereotypic dorsiflexions of the huge toe with fanning of the little toes with flexion of the lower legs, knees, & thighs Recur in interims RLS/PLMD

Slide 19

Primary RLS Secondary RLS Iron Deficiency Renal Failure Pregnancy Medications TCA, SSRI, Dopamine adversaries (compazine, metaclopramide) Caffeine PLMD Any reason for RLS Withdrawal of anticonvulsants, barbiturates, hypnotics Associated with SDB, CPAP titration, and Narcolepsy RLS/PLMD

Slide 20

SHHS 2821 men and ladies RLS dx by 8-thing poll and corresponded with PSG discoveries Health Related Quality of Life SF-36 Decrements in ALL physical spaces Decrements in Psychiatric areas of " Mental Health " and " Vitality " Dose-reaction relationship RLS and QoL Winkelman et al. Polysomnographic and Health-related Quality of Life Correlates of Restless Legs Syndrome in the Sleep Heart Health Study. Rest 32(6) 2009 772-778.

Slide 21

RLS in group test of Korean Adults 6,509 subjects Age 18-64 Face-to-face talk with, K-CIDI, CES-D-K and EQ-5D Prevalence Women (1.3%) Men (0.6%) Increased with age RLS and Psychiatric Disorders Cho et al. Fretful Legs Syndrome in a Community Sample of Korean Adults: Prevalence, Impact on Quality of Life, and Association with DSM-IV Psychiatric Disorders . Rest. 32(8) 2009 1069-1076.

Slide 22

Results Psychotropics (12.5% versus 3%) Anxiety or sadness (21.1% versus 12.6%) Mean CES-D score (10.8 versus 6.4) Lifetime Prevalence of DSM-IV Disorders 40.3% versus 27.7% MDD most regular (15.3% versus 8.3%) Anxiety issue expanded also (13.9% versus 6.7%) RLS and Psychiatric Disorders (cont) Cho et al. Anxious Legs Syndrome in a Community Sample of Korean Adults: Prevalence, Impact on Quality of Life, and Association with DSM-IV Psychiatric Disorders . Rest. 32(8) 2009 1069-1076.

Slide 23

Review Depression more basic in RLS/PLMD exacerbated in those on SSRI " s/SNRI " s RLS/PLMD enhanced or like control for buproprion and trazodone RLS, PLMD and Depression Picchietti and Winkelman. Anxious Legs Syndrome, Periodic Limb Movements in Sleep, and Depression. Rest. 28(7) 2005 891-898.

Slide 24

REM Disorder Onset late adolescence to 20 " s Signs/Symptoms EDS Sleep Attacks Cataplexy Hypnagogic Hallucinations Sleep Paralysis Secondary Causes Head injury Stroke MS Brain Tumors NG Disorders CNS contaminations Diagnosis PSG with MSLT HLA antigens CSF Narcolepsy

Slide 25

Psychosocial Morbidity Study Cross-sectional poll review Children matured 4-18 Narcolepsy, Behavior, Mood, QoL. Also, Educational Assessments Subjects 42 subjects with Narcolepsy 18 with EDS without cataplexy 23 control amass No demographic contrasts between gatherings Narcolepsy and Psychiatry Stores et al. The Psychosocial Problems of Children with Narcolepsy and those with Excessive Daytime Sleepiness of Uncertain Origin. Pediatrics. 118(4) 2006 e1116-e1123.

Slide 26

Results Significant contrasts for associate issues, lead, enthusiastic side effects and aggregate issues Prosocial and hyperactivity not quite the same as controls CDI expanded in Narcolepsy and EDS assemble Mental Health QoL influence however not physical or worldwide Greater instructive troubles Increased psychosocial dreariness Narcolepsy and Psychiatry (cont.)

Slide 27

SANS, SAPS, BPRS Patients 2-5 (not benefit for pt 1) had measurably and clinically noteworthy change of SANS, SAPS, and BPRS on stimulants. Narcolepsy and Schizophrenia Case Series (5) All female, mean age 39+/ - 6.8 Tx stubborn schizophrenia and EDS All chose had narcolepsy quadruplicate Douglas et al. Flowery Refractory Schizophrenias that end up being Treatable Variants of HLA-Associated Narcolepsy. J Nerv Ment Dis. 179:012-017, 1991, 12-17.

Slide 28

Sleep issue are normal Sleep issue have related grimness/mortality Sleep issue are undervalued The relationship between rest issue and psychiatric issue shows up bi-directional Identification and treatment of Primary Sleep issue may enhance psychiatric comorbidity Summary

Slide 29

Questions

Recommended
View more...