Vol 7 No.4 - Sleep Disorders, Neuropsychiatry, and Psychotropics
Past issues Contributors How to publish Contributions and comments Home
 
he discussion of the relationship between sleep and psychiatric states is not new. Sleep disorders medi- cine and psychiatry are related in numerous ways. Even though most psychiatric patients have a complaint about sleep, a primary sleep disorder may also result in neu- ropsychiatric complications. In fact, psychiatric morbid- ity is very high in patients seen in the sleep disorders clinic. In 1989, Mosko et al1 showed that 67% of patients who presented to a sleep disorders center reported an episode of depression within the previous 5 years, and 26% described themselves as depressed at presentation. The high incidence of depressive feelings in patients with a  sleep  complaint  was  true  not  only  of  patients  with insomnia, but also for those with organic sleep disorders (such as obstructive sleep apnea/hypopnea syndrome [OSAS], narcolepsy, or periodic leg movements during sleep [PLMS]). In a more recent survey,Vandeputte and de Weerd2 also found that mood disorders are extremely common in patients who present at a sleep center.These authors  analyzed  data  from  917  consecutive  patients (excluding those with clinically overt depression) and found elevated scores of depression in patients diagnosed with psychophysiological insomnia (60.5%), but also in OSAS (41%), narcolepsy (37%), periodic limb move- ment  disorder/restless  legs  syndrome  (PLMD/RLS) (53%), inadequate sleep/wake hygiene (63%), delayed sleep phase syndrome (DSPS) (41%), snoring (31%), sleep  state  misperception  (63%), parasomnia  (29%), idiopathic hypersomnia (27.5%), and advanced sleep phase  syndrome  (83%). Although  the  prevalence  of 3 3 5 C l i n i c a l   r e s e a r c h T Copyright © 2005 LLS SAS.  All rights reserved www.dialogues-cns.org Psychiatric aspects of organic sleep disorders José Haba-Rubio, MD Keywords:  sleep; mood disorder; narcolepsy; idiopathic hypersomnia; sleep apnea syndrome; restless legs syndrome; periodic limb movement disorder; cir- cadian sleep disorder; quality of life Author  affiliations:  Sleep  Laboratory,  Department  of  Psychiatry,  University Hospital, Geneva, Switzerland Address for correspondence:  José Haba-Rubio, MD, Sleep Laboratory, Department of Psychiatry, Geneva University Hospital, Belle-Idée, 2, Chemin du Petit-Bel-Air, CH 1204-Chêne-Bourg, Switzerland (e-mail: jose.habarubio@hcuge.ch) In recent years, a number of studies have attempted to characterize psychological disturbances related to various sleep disorders. The objective of this type of research is to investigate the possibility that psychopathology may rep- resent an etiological factor, a complication, and/or a tar- get for treatment. In addition, disordered sleep can pre- sent itself in a complex and atypical fashion in which the primary sleep-related component may not be immediately apparent. This article reviews the evidence for a relation- ship between organic sleep disorders and psychiatric mor- bidity. Generally, it can be concluded that organic sleep disorders  have  a  profound  negative  impact  on  most domains of health-related quality of life. Results for the sleep disorders that have been studied (narcolepsy, idio- pathic hypersomnia, sleep apnea/hypopnea syndrome, restless legs syndrome, periodic limb movement disorder, and circadian sleep disorders) show strong evidence for an  association  with  mood  disorders.  After  treatment, depression scores may or may not improve to the level of population norms, suggesting that this relationship is more complex than one of mere cause and effect.   © 2005, LLS SAS Dialogues Clin Neurosci. 2005;7:335-346.