0858 Under reporting of Apnea Hypopnea Index (AHI) in patients with predominant REM sleep disordered breathing on antidepressants

Abstract

Abstract Introduction The prevalence of Rapid Eye Movement (REM) related Sleep Disordered Breathing (SDB) ranges from 13.5% to 36.7% in patients suspicious to have SDB.1 It is reported that patients with REM related SDB often have associated depression and are commonly on anti-depressants.2 Antidepressants suppress overall REM sleep duration. Significant sleep disordered breathing is known to occur during REM sleep. These patients commonly present with excessive daytime sleepiness and fatigue. Obstructive sleep apnea (OSA) diagnosis is often missed in these patients secondary to REM sleep suppression and subsequent underreporting of AHI.1. Conwell W, Patel B etal 2012 PMID: 21614575. 2. Geckil AA, Ermis H. 2020 PMID: 30949927. Report of Cases: Case 1 is a 53-year-old obese white female with stable depression on citalopram 20mg presented with witnessed loud snoring and apneas, sleep onset and maintenance insomnia, daytime fatigue and hypersomnolence. Her Epworth Sleep Score (ESS) was 13/24. Her in lab baseline polysomnogram demonstrated overall AHI 3.8/hour and REM only AHI 24.3/hour. To further explore her persistent daytime sleepiness a Mean Sleep Latency Test (MSLT) was ordered. Citalopram was held 2 weeks prior to MSLT. In the PSG her overall AHI increased to 7.6/hour diagnosing her with mild OSA. PAP therapy was initiated that improved patients nocturnal sleep, daytime fatigue and hypersomnolence. Case 2 is a 54-year-old overweight white female with past medical history of chronic stable depression on Wellbutrin SR 100 mg daily presented with significant day time fatigue and hypersomnolence (ESS 15/24). Her baseline PSG reported AHI 1.7/hour with REM only AHI 10.7/hour. However due to persistent excessive daytime sleepiness MSLT was ordered. Her Wellbutrin was held 2 weeks prior to testing. Her overnight PSG demonstrated increase in her AHI to 7.9/hour and REM AHI to 34.2/hour. Mild obstructive sleep apnea was diagnosed, and PAP therapy was initiated that improved her hypersomnolence. Conclusion These cases illustrate that antidepressants likely mask obstructive sleep apnea by suppressing REM sleep. Given the underreported AHI in patients with REM SDB who are on anti-depressants it may be prudent to hold anti-depressants for 2 weeks to establish an accurate diagnosis of sleep apnea. Support (If Any)