Title: Overlap of Attention Deficit and Hyperreactivity Disorder with Obstructive Sleep Apnea – A Case Presentation

Abstract

Introduction: Obstructive sleep apnea (OSA) is more prevalent in psychiatric patients than in general population. Early diagnosis and adequate management of OSA could improve prognosis in this category. Methods: We present a case of moderate OSA in a patient with attention deficit and hyperreactivity disorder (ADHD) with prominent symptoms following a H1N1 viral encephalitis. Results and discussion: 31 years-old male, night shift-worker, active smoker, overweight, on long-term psychotropic therapy (extended release methylphenidate), with partial response to therapy. Reports frequent arousals, sometimes feeling like gasping or choking, unrefreshing sleep, chronic fatigue. Epworth Sleepiness Scale score was 10/24 (excessive daytime sleepiness). STOP-Bang Questionnaire score was 3/8 (high risk of OSA). Home unattended cardio-respiratory poligraphy identified moderate OSA and Positive Airway Pressure (PAP) therapy was prescribed. At 1 year follow-up: works during daytime, improved performance with lower dose of stimulant medication; agrees to adhere to a smoking cessation programme; no weight loss. OSA could be responsible for both night time and daytime symptoms in psychiatric patients. The STOP-Bang Questionnaire (a screening tool for OSA) identifies subjects at risk for this condition. PAP therapy improved the patient’s performance and also allowed lowering of psychotropic medication dose. Research support: No conflict of interest to disclose.