1248 Hypersomnia with Pseudo-Cataplexy Associated with Schizoaffective Disorder: A Case Report

Abstract

Abstract Introduction Psychiatric illness is an important potential cause of excessive daytime sleepiness (EDS), hypersomnia, and narcolepsy-like symptoms. We report a case of hypersomnia and pseudo-cataplexy associated with schizoaffective disorder. Report of Case A 28-year-old man with obstructive sleep apnea (OSA) and schizoaffective disorder presented to our sleep medicine clinic complaining of EDS, cataplexy-like attacks, sleep paralysis, depressed mood, and dream intrusion. Questions about cataplexy often provoked brief episodes of speech arrest, eye closure, and neck flexion lasting a few seconds. An MSLT with CPAP showed a mean sleep latency of 3 minutes and 3 sleep onset REM periods (SOREMPs); however, actigraphy showed that the SOREMPs occurred during the patient’s habitual sleep period and the patient discontinued a REM-suppressing medication within a few days of the study. The HLA-DQB1*0602 allele was absent. Following circadian adjustment, a repeat MSLT with CPAP showed zero sleep and no SOREMPs. The preceding polysomnogram showed a total sleep time (TST) of 7.8 hours, no epileptiform activity, adequately-treated OSA, and a REM latency of 53 minutes. Prior to these studies, two weeks of sleep diary and actigraphy showed a TST greater than 10 hours. Ultimately, treatment of the patient’s psychiatric disorder resulted in a reduction of his EDS and TST. Conclusion Patients with psychiatric illness can present with hypersomnia, EDS, and narcolepsy-like symptoms such as pseudo-cataplexy. Misdiagnosing such a patient with narcolepsy can lead to treatments capable of worsening the primary underlying psychiatric disturbance. MSLT results must be interpreted in the context of a patient’s clinical history and sleep schedule; if there is concern for a false positive result, repeat testing should be considered.