People who have difficulty sleeping at night or staying awake during the day may suffer from more than just a sleep disorder. According to a new study presented at CHEST 2004, the 70th annual international scientific assembly of the American College of Chest Physicians (ACCP), the majority of patients with obstructive sleep apnea (OSA) and/or nonrestorative sleep have a high degree of attention deficit, as well as neuromuscular and psychiatric conditions.
"Although sleep apnea is clearly linked to attention deficit in adults, treating the sleep disorder may not always improve a patient's daytime attention and cognition," said the study's lead author, Clifford G. Risk, MD, PhD, FCCP, Marlborough Center for Sleep Disorders, Marlborough, MA. "Many people with a sleep disorder and attention deficit may suffer from multiple underlying conditions, such as fibromyalgia and chronic fatigue, that are reflected during sleep and disrupt the sleep process."
Dr. Risk and colleagues from the Marlborough Center for Sleep Disorders administered polysomnograms (PSGs) to 50 patients who presented to a sleep center for nonrestorative sleep, daytime sleepiness, and fatigue and found that 33 patients (66.0%) suffered from OSA. Daytime sleepiness levels were then evaluated using the Epworth Sleepiness Scale (ESS), a self-report questionnaire on a scale of 0 to 24, and attention deficit was measured by the Adult Self-Report Scale (ASRS) Symptom Checklist, on a scale of 0 to 36. Following treatment with continuous positive airway pressure (CPAP), the average ESS score for patients with sleep apnea improved significantly, from 11.6 to 2.7, and the average ASRS score was significantly reduced, from 17.4 to 10.4. Researchers identified 15 patients with possible or probable attention deficit disorder (ADD), on the basis of having a moderate-to-severe impaired ASRS score, and found that with CPAP treatment, nine of these patients (60%) dropped into normal ranges. Further testing showed that the remaining six patients suffered from comorbid diagnoses of primary ADD, severe memory impairment, depression, dyslexia, and illiteracy.
"The sleep specialist is not finished when he diagnoses and treats OSA or insomnia," said Dr. Risk. "A multidisciplinary assessment and treatment program may be necessary in order to isolate additional comorbidities that are causing persistent impairment."
Study results also showed a high degree of attention deficit in non-OSA patients with insomnia or a lack of deep, restorative sleep. Test results indicated that 28 patients suffered from neuromuscular disorders and mood and anxiety disorders. Ten patients suffered from primary neuromuscular disorders, such as fibromyalgia, chronic fatigue, or multiple sclerosis; 14 patients suffered from a primary psychological disorder, such as depression, bipolar disorder, or anxiety; and four of the patients on CPAP, whose ASRS was still impaired, were affected by depression or fatigue.
"Patients with sleep disorders, who are not assessed for additional conditions, may continue to suffer from significant health problems," said Paul A. Kvale, MD, FCCP, President of the American College of Chest Physicians. "When seeing a specialist about a sleep disorder, patients should inform their health-care provider of any related conditions that could be contributing to their sleeping difficulties."