CPAP Induced Manic Episode in a Patient with Bipolar Disorder: A Case Report of Central Sleep Apnea - Abstract
Objective: In this case report we present our laboratory observations of one patient with bipolar disorder and central sleep apnea (CSA) who was treated with continuous positive airway pressure (CPAP) for their sleep apnea.
Background: Bipolar disorder is a psychiatric disorder characterized by episodes of mania, hypomania and major depression. This disorder affects approximately 0.8% of the adult population. Bipolar disorder frequently disrupts mood, energy, sleep, cognition, behavior and patients thus struggle to maintain employment and interpersonal relationships. Obstructive sleep apnea is a fully described and well-recognized entity. Central sleep apnea (CSA), however, has been poorly studied. The prevalence of obstructive sleep apnea (OSA) is expected to be high in bipolar disorder due to accompanying comorbid obesity. There is no evidence according to frequency of CSA in the patients with bipolar disorder. Coexistence of CSA and bipolar disorder has not been previously reported.
Results: The case of bipolar disorder, CPAP was started after a polysomnographic diagnosis of CSA and CPAP titration study indicating that most of the apneas/hypopneas were eliminated with a significant improvement in oxygen saturation. It was very remarkable that in this case initiation of CPAP resulted in manic symptoms and also symptoms of the REM behavior disorder.
Conclusions: Psychiatrists, especially laboratory physicians and other clinicians need to monitor patients with bipolar disorder closely for worsening of manic symptoms when they are started on CPAP for underlying mild OSA and especially severe CSA.