Psych Vivas · Specialty psychiatry — sleep medicine interface
Obstructive sleep apnoea and psychiatry — structured clinical viva
Fellowship viva on OSA in SMI, SGA weight gain, sedative risk, PAP adherence, and safety.
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Target exams
FRANZCPMRCPsychABPNMD-DNB
Prompt
You are the psychiatry registrar in a clozapine clinic. A 41-year-old man with schizophrenia has gained 18 kg on olanzapine then clozapine. He falls asleep in group programmes, scores high on sleepiness measures, partners report snoring and apnoeas, and nursing staff request 'stronger night sedation' because he is restless at 02:00. BMI 39, BP 150/95. Discuss OSA probability, why more benzodiazepines are the wrong answer, investigation pathway, PAP role, metabolic monitoring, adherence barriers in psychosis, and driving advice.
Interpretation
Reveal interpretationShowHide
High pretest OSA in a man with schizophrenia, major SGA-related weight gain, EDS, snoring/apnoeas, and hypertension. The request for stronger night sedation is the wrong vector — sedatives may worsen SDB and respiratory risk. Clozapine is likely still indicated for psychosis; the airway and metabolic problems need concurrent management.[1][2][5]
References8ShowHide
- [1]Stubbs B, Vancampfort D, Veronese N, et al. The prevalence and predictors of obstructive sleep apnea in major depressive disorder, bipolar disorder and schizophrenia J Affect Disord, 2016.PMID 26999550
- [2]Gupta MA, Simpson FC Obstructive sleep apnea and psychiatric disorders: a systematic review J Clin Sleep Med, 2015.PMID 25406268
- [3]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
- [4]Patil SP, Ayappa IA, Caples SM, et al. Treatment of Adult Obstructive Sleep Apnea With Positive Airway Pressure J Clin Sleep Med, 2019.PMID 30736888
- [5]Mason M, Cates CJ, Smith I Effects of opioid, hypnotic and sedating medications on sleep-disordered breathing Cochrane Database Syst Rev, 2015.PMID 26171909
- [6]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
- [7]Monti JM The effect of second-generation antipsychotic drugs on sleep parameters Sleep Med, 2016.PMID 27692282
- [8]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