Obstructive Sleep Apnea and Depression in the Elderly

Karl Doghramji, MD and Paul Doghramji, MD

Karl Doghramji, MD
Professor of Psychiatry and Human Behavior
Jefferson Medical College
Director of the Sleep Disorders Center
Thomas Jefferson University Hospital
Philadelphia, Pennsylvania

Paul P. Doghramji, MD, FAAFP
Family Physician, Collegeville Family Practice
Medical Director, Ursinus College
Collegeville, Pennsylvania

A 71 year old man was taken to see his physician because of excessive sleepiness and a loss of interest in his usual activities. According to his daughter, the patient’s symptoms began 6 months prior, following the death of his wife. His doctor started him on an antidepressant, but after 5 months of treatment with no signs of improvement, he was placed into assisted living by his daughter. Shortly thereafter, one of the nurses at the patient’s facility called his doctor to report that his nightly snoring was so loud, it could be heard down the hall. Upon examination, the patient was found to have the cardinal symptoms of obstructive sleep apnea. Evaluation with the Epworth Sleepiness Scale gave positive results for sleep disturbance, and a subsequent study at a sleep center confirmed the diagnosis of obstructive sleep apnea. As recommended by the sleep center, the patient began using CPAP at night, which significantly improved his symptoms within 3 months. Here, Dr. Karl Doghramji and Dr. Paul Doghramji discuss the relationship between sleep disturbance and depression, including techniques for differential diagnosis and relevant treatment options.

References

Chasens ER, Sereika SM, Houze MP, Strollo PJ. Subjective and objective appraisal of activity in adults with obstructive sleep apnea. J Aging Res. 2011;2011:751819.
El-Ad B, Lavie P. Effect of sleep apnea on cognition and mood. Int Rev Psychiatry. 2005;17:277-282.
Gasquoine PG. Cognitive impairment in common, noncentral nervous system medical conditions of adults and the elderly. J Clin Exp Neuropsychol. 2011;33:486-496.
Lam JC, Ip MS. An update on obstructive sleep apnea and the metabolic syndrome. Curr Opin Pulm Med. 2007;13:484-489

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