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Patients With Sleep Apnea May Have Comorbid Conditions: Presented at CHEST

By Bonnie Darves

SEATTLE, WA -- October 27, 2004 -- Patients with disorders such as obstructive sleep apnea (OSP) that impair daytime cognition may also suffer from a range of other conditions, including attention deficit disorder (ADD), depression, anxiety, and neuromuscular disorders, say researchers.

Although a clear correlation between ADD and OSA-related sleep disruption has been demonstrated, physicians whose patients have been diagnosed with OSA should look for other underlying comorbid conditions and ensure patients receive appropriate treatment for all conditions, said Clifford Risk, MD, PhD, director of the Marlborough Center for Sleep Disorders in Marlborough, Massachusetts. Dr. Risk spoke in a presentation here at Chest 2004, the 70th annual scientific assembly of the American College of Chest Physicians.

In order to identify other conditions that may also be present and which may contribute to health problems that persist after treatment, Dr. Risk said, "Even after OSA or insomnia have been treated, a multidisciplinary approach may be needed."

In a study of 50 patients who sought treatment at the center for nonrestorative sleep, fatigue, or daytime sleepiness, 34 patients were diagnosed with OSA. After treatment with continuous positive airway pressure (CPAP), average Epworth Sleepiness Scale (ESS) scores improved from 11.6 to 2.7 in patients with OSA.

Yet the researchers found that many of the patients had other conditions that may have been affected by the sleep disorder. In particular, 15 patients were found to have possible or probable ADD, and 28 were found to have either a mood disorder --primarily anxiety or depression --or a neuromuscular disorder such as fibromyalgia or multiple sclerosis. Other comorbid conditions uncovered in the study patients included severe memory impairment, dyslexia, and illiteracy.

About half of the patients with comorbid OSA and ADD experienced significant improvement in their ADD symptoms after their OSA was treated with continuous positive airway pressure (CPAP), Risk said. In patients with suspected ADD, Adult Self-Report Scale (ASRS) Symptom Checklist scores, measured on a scale of 0 to 36, dropped from 17.4 to 10.4. But the remaining patients did not improve, indicating the need for ADD-targeted assessment and treatment, he added. "ADD scores dropped by about 40 percent [overall] but did not go into the normal range for some of those patients --and we don't know why. The bottom line is that the sleep specialist's work may not be finished after the apnea is cured."


[Presentation title: Impact of Continuous Positive Airway Pressure Treatment on Attention Deficit in Obstructive Sleep Apnea. No abstract number.]

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