Introduction: Obstructive sleep apnea syndrome (OSAS) is characterized by repetitive episodes of apnea and hypopnea, and decrease in oxygen saturation (1). The relationship of OSAS and other medical conditions has been explored in the research literature while the relationship between OSAS and mental health has not been sufficiently investigated yet. The aim of this study was to determine the distribution of mental disorders and the type of distribution of mental disorders within clinical features of OSAS from the point of view of psychiatry.
Method: The patients, who were referred to the sleep disorders unit of Karadeniz Technical University, Faculty of Medicine Hospital for 1 year were considered the population for this study. A total of 102 patients, with a diagnosis of OSAS according to polysomnography and patients with no exclusion criteria composed the sample of the study. The patients were classified according to the ICSD-2 (The International Classification of Sleep Disorders) with polysomnography. Sociodemographical and clinical features of the patients were recorded. The Montgomery Asberg Depression Rating Scale, the Beck Depression Inventory and the Epworth Sleepiness Scale were administered. Psychiatric diagnoses were made by interviews based on the DSM-IV Axis I Disorders (SCID-I).
Results: According to the ICDSD-2, 19.6% (n=20) of the patients had a mild, 29.4% (n=30) had a moderate and 51,0% (n=52) had a severe form of OSAS. The distribution of sex, marital status, and occupation are shown in Table I. The means of weight and height of the whole sample were 91.15±16.78kg and 168.23±8.76cm, respectively. Fifty-seven point nine percent of the patients (n=59) had had a psychiatric referral previously, 42.2% of them (n=43) did not. According to the body mass index (BMI), 5.9% of patients (n=6) were within normal limits, 30.4% were (n=31) overweight, 54.9% were obese (n=59) and 8.8% were morbidly obese (n=9). The Epworth Sleepiness Scale total score was significantly higher in severe OSAS patients (p=0.002). The relationship of mild and moderate OSAS with BMI was significant (p=0.010). The median age of severe OSAS patients was significantly higher than mild OSAS patients (p=0.0529). Thirty-one point four percent (n=32) of patients had 1 diagnosis according to the SCID-I, 22.5% (n=23) had more than one diagnosis, and 46.1% (n=47) did not have any diagnosis. The total scores of the BDI and the MADRS were 5.49±9.05 and 5.82±9.40, respectively.
Discussion: There are many risk factors for OSAS. Male predominance is present for adult OSAS patients. The number of male patients was higher than female patients in this study. One of the most important risk factor is obesity (2). Most of the patients were obese or morbidly obese in our group. The detected depression rate was correlated with many studies which reported higher depression rates in OSAS (2-5). In this study the rate of anxiety disorders was higher than in the healthy population while being similar or lower than the rate estimated in previous studies with OSAS patients.
Conclusion: Mental disorders associated with medical diseases are important clinical syndromes effecting morbidity and mortality. Recognizing the symptoms and signs of OSAS is important. Regarding this issue, further studies with larger samples comparing different subgroups are needed.