Comorbid Sleep and Psychiatric Disorders: Rx of the Former Can Improve the Latter

Sleep disorders - most commonly sleep apnea - are often comorbid with psychiatric disorders. Treatment of disordered sleep can result in a significant improvement in the psychiatric disorder, an expert in sleep disorders said this week at the APA’s new research briefing.

Umesh Vyas, MD, Medical Director of the Sleep Disorders Center at the Mayo Clinic Health System in Mankato, Minn, noted that “sleep disorders are very common, and many sleep symptoms are part of the diagnostic criteria for psychiatric disorders. Disturbances in the quality and quantity of sleep often exacerbate underlying psychological distress and psychiatric illness." Vyas is also Chair of the Department of Psychiatry and Medical Director for the Inpatient Behavioral Health Unit at the Mayo Clinic in Mankato.

During his fellowship in sleep disorders, Vyas conducted a retrospective chart review at the Veterans Affairs Medical Center Sleep Disorders Clinic in Milwaukee, from October to December 2007. He reviewed more than 150 patient charts, 117 of which met review criteria. There were no deaths from suicide, he emphasized: patients died from heart failure and other ailments.

Of the 117 who met review criteria, 97.6% were male, most between 41 and 80 years old. (The patient population was comprised of veterans). Nearly half (46.2%) of these patients had co-existing psychiatric and sleep disorder diagnoses. Outcomes in patients with co-morbid sleep and psychiatric disorders were recorded at 6, 12, and 24 months after initiation of sleep disorder treatment. The patients received a baseline psychiatric status score of 0. Change in status at each subsequent time point was scored using five parameters: +2 (marked improvement); +1 (mild improvement); 0 (no change); -1 (mild worsening); or -2 (marked worsening).

Compared with baseline, the patients’ psychiatric status progressively improved over the 2 years of follow-up, Vyas said. Change in the average score was +0.45 at 6 months, +0.56 at 12 months, and +0.79 at 24 months (p<0.0001). 

No significant improvement was observed for a specific psychiatric disorder, he added. This may be due, he said, to the small number for a specific psychiatric disorder and because most patients had various co-existing psychiatric disorders.

Compliance with sleep disorder treatment was compared between patients with and without psychiatric disorders. Vyas concluded that having a psychiatric disorder did not affect compliance with sleep disorder therapy.

Noting the limits of a retrospective study, Vyas said, “There is a strong need for prospective studies with more subjects.”

Vyas acknowledged that medications for sleep problems, smoking, and other psychiatric medications can exacerbate sleep disorders and that psychiatric issues can increase the risk for and precipitate sleep disorders. There is a “bi-directional” process occurring, he said: sleep disorders affect psychiatric disorders and psychiatric disorders and pharmacological treatments affect sleep.