1025 Schizophrenic Patient with Large REM Rebound Following Treatment of Severe Obstructive Sleep Apnea

Abstract

Abstract Introduction We present a case of uncontrolled schizophrenia with severe obstructive sleep apnea (OSA) and significant REM rebound after bilevel positive airway pressure (BPAP) therapy. Report of case(s) A 74-year-old female, with Schizophrenia on anti-psychotic therapy, presented to the sleep clinic due to excessive daytime sleepiness (EDS) and an Epworth score of 21/24. Diagnostic polysomnogram (PSG) reported an AHI of 162.1 events/hour with SaO2 nadir of 71% with sleep efficiency of 31.6% and no REM-sleep, consistent with severe OSA. The next morning, multiple sleep latency testing (MSLT) demonstrated mean sleep latency (MSL) of 3.6 minutes with 0 REM-onset sleep periods (SOREMPs). Patient underwent CPAP/BPAP titration which improved sleep efficiency to 88.6% and severe REM rebound at 61.7%. MSLT after the titration study demonstrated MSL of 4.0 minutes and 3 SOREMPs and was initiated on BPAP therapy at 20/13 cmH2O. A repeat PSG, 4 weeks later showed normalization of sleep architecture. After starting PAP therapy, the patient had a significant improvement in EDS but also energy and interest levels and denied feelings of sadness, racing or paranoid thoughts. Her social life improved and started exercising regularly and volunteering in the community. There was also improved blood pressure and blood sugar levels. She was followed up in the sleep clinic regularly and remained compliant with and benefiting from BPAP therapy and was continued on anti-psychotic therapy. Conclusion Untreated OSA often requires repetitive arousals to reopen the obstructed upper-airway that results in increased non-REM sleep at the expense of slow wave sleep and REM sleep. PAP therapy can cause a rebound increase in REM and SWS. OSA is under recognized in schizophrenic patients and other psychiatric disorders which results in development of significant comorbidities with greater severity of psychiatric symptoms. Elevated rates of OSA have been seen in the schizophrenic population. Treatment of OSA helps with not only physical but also psychotic symptoms. Many anti-psychotics, due to causing weight gain, may contribute to OSA. Studies also indicated that CPAP response to OSA, was as favorable in people with severe mental illness, compared to other patient groups. Support (if any) REM rebound and CPAP compliance; B. Koo, R. Wiggins, C. Molina