Psych · Specialty psychiatry — sleep medicine interface
Obstructive sleep apnoea and psychiatry
Also known as OSA · Obstructive sleep apnea · Sleep-disordered breathing · CPAP psychiatry · STOP-BANG · Apnoea-hypopnoea index · OSA depression
Exam-exhaustive fellowship reference on obstructive sleep apnoea at the psychiatry interface — ICSD-3/AASM severity, epidemiology, mood and cognitive comorbidity, STOP-BANG screening, PSG/HSAT pathways, CPAP first-line care with SAVE caveats, psychotropic airway and weight effects, benzodiazepine risk, driving safety, and special populations. FRANZCP-primary, globally tagged.
Practise this topic
On this page
Study tools
Your progress
Saved on this device.
Target exams
Red flags
- Witnessed apnoeas with cyanosis, acute hypercapnic failure, or cor pulmonale — medical emergency pathway, not outpatient psychiatry alone
- Excessive daytime sleepiness with near-miss or actual driving/machinery incidents — urgent fitness assessment and OSA work-up
- Treatment-resistant depression with obesity, loud snoring, and residual anergia — exclude OSA before endless antidepressant switches
- Benzodiazepine or opioid co-prescribing in untreated moderate–severe OSA — de-escalate sedatives and arrange urgent medical/sleep review
- Severe comorbid depression with suicidal ideation and unrefreshing sleep — treat risk and sleep pathology together
- Rapid weight gain on SGAs with new hypersomnolence — screen OSA and metabolic complications
Meet the patient
A 47-year-old with "treatment-resistant depression" has failed three antidepressants. He is obese, his wife reports he stops breathing then gasps at night, he falls asleep in the waiting room, and his PHQ-9 has not budged in a year. The last psychiatrist raised the mirtazapine.[6][7]
The whole topic hides in that waiting-room doze. The exam question he answers: "What did every clinician miss, and what is the first-line treatment that is not a tablet?" Untreated OSA produces the exact phenotype of residual MDD — anergia, irritability, cognitive slowing, unrefreshing sleep — and no amount of antidepressant titration fixes an airway that collapses nightly.[5][6][9]
References23ShowHide
- [1]Young T, Palta M, Dempsey J, et al. The occurrence of sleep-disordered breathing among middle-aged adults N Engl J Med, 1993.PMID 8464434
- [2]Peppard PE, Young T, Barnet JH, et al. Increased prevalence of sleep-disordered breathing in adults Am J Epidemiol, 2013.PMID 23589584
- [3]Heinzer R, Vat S, Marques-Vidal P, et al. Prevalence of sleep-disordered breathing in the general population: the HypnoLaus study Lancet Respir Med, 2015.PMID 25682233
- [4]Benjafield AV, Ayas NT, Eastwood PR, et al. Estimation of the global prevalence and burden of obstructive sleep apnoea: a literature-based analysis Lancet Respir Med, 2019.PMID 31300334
- [5]Peppard PE, Szklo-Coxe M, Hla KM, et al. Longitudinal association of sleep-related breathing disorder and depression Arch Intern Med, 2006.PMID 16983048
- [6]Gupta MA, Simpson FC Obstructive sleep apnea and psychiatric disorders: a systematic review J Clin Sleep Med, 2015.PMID 25406268
- [7]Stubbs B, Vancampfort D, Veronese N, et al. The prevalence and predictors of obstructive sleep apnea in major depressive disorder, bipolar disorder and schizophrenia: A systematic review and meta-analysis J Affect Disord, 2016.PMID 26999550
- [8]Wheaton AG, Perry GS, Chapman DP, et al. Sleep disordered breathing and depression among U.S. adults: National Health and Nutrition Examination Survey, 2005-2008 Sleep, 2012.PMID 22467983
- [9]Edwards C, Mukherjee S, Simpson L, et al. Depressive Symptoms before and after Treatment of Obstructive Sleep Apnea in Men and Women J Clin Sleep Med, 2015.PMID 25902824
- [10]Zheng D, Xu Y, You S, et al. Effects of continuous positive airway pressure on depression and anxiety symptoms in patients with obstructive sleep apnoea: results from the sleep apnoea cardiovascular Endpoint randomised trial and meta-analysis EClinicalMedicine, 2019.PMID 31312807
- [11]Chung F, Yegneswaran B, Liao P, et al. STOP questionnaire: a tool to screen patients for obstructive sleep apnea Anesthesiology, 2008.PMID 18431116
- [12]Chung F, Subramanyam R, Liao P, et al. High STOP-Bang score indicates a high probability of obstructive sleep apnoea Br J Anaesth, 2012.PMID 22401881
- [13]Kapur VK, Auckley DH, Chowdhuri S, et al. Clinical Practice Guideline for Diagnostic Testing for Adult Obstructive Sleep Apnea: An American Academy of Sleep Medicine Clinical Practice Guideline J Clin Sleep Med, 2017.PMID 28162150
- [14]Patil SP, Ayappa IA, Caples SM, et al. Treatment of Adult Obstructive Sleep Apnea With Positive Airway Pressure: An American Academy of Sleep Medicine Systematic Review, Meta-Analysis, and GRADE Assessment J Clin Sleep Med, 2019.PMID 30736888
- [15]Epstein LJ, Kristo D, Strollo PJ Jr, et al. Clinical guideline for the evaluation, management and long-term care of obstructive sleep apnea in adults J Clin Sleep Med, 2009.PMID 19960649
- [16]McEvoy RD, Antic NA, Heeley E, et al. CPAP for Prevention of Cardiovascular Events in Obstructive Sleep Apnea N Engl J Med, 2016.PMID 27571048
- [17]Mason M, Cates CJ, Smith I Effects of opioid, hypnotic and sedating medications on sleep-disordered breathing in adults with obstructive sleep apnoea Cochrane Database Syst Rev, 2015.PMID 26171909
- [18]Wang SH, Chen WS, Tang SE, et al. Benzodiazepines Associated With Acute Respiratory Failure in Patients With Obstructive Sleep Apnea Front Pharmacol, 2018.PMID 30666205
- [19]Wichniak A, Wierzbicka A, Walecka M, et al. Effects of Antidepressants on Sleep Curr Psychiatry Rep, 2017.PMID 28791566
- [20]Monti JM, Torterolo P, Pandi Perumal SR The effect of second-generation antipsychotic drugs on sleep parameters in patients with unipolar or bipolar disorder Sleep Med, 2016.PMID 27692282
- [21]Sateia MJ International classification of sleep disorders-third edition: highlights and modifications Chest, 2014.PMID 25367475
- [22]Qaseem A, Dallas P, Owens DK, et al. Diagnosis of obstructive sleep apnea in adults: a clinical practice guideline from the American College of Physicians Ann Intern Med, 2014.PMID 25089864
- [23]Yu J, Zhou Z, McEvoy RD, et al. Association of Positive Airway Pressure With Cardiovascular Events and Death in Adults With Sleep Apnea: A Systematic Review and Meta-analysis JAMA, 2017.PMID 28697252