SLEEP 2011 Abstract Supplement

B. Clinical Sleep Science IX. Psychiatric and Behavioral Disorders and Sleep
0732
PSYCHIATRIC CO MORBIDITIES IN AFRICAN AMERICAN
PATIENTS PRESENTING TO SLEEP DISORDERS CLINIC
Khurshid K 1 , Khan RA 2 , Fatima S 3
1
Psychiatry, Howard University Hospital, Washington, DC, USA,
2
Neurology, Howard University Hospital, Washington, DC, USA,
3
Neurology, Georgetown University Hospital, Washington, DC, USA
Introduction: Psychiatric disorders are common in patients presenting
in primary care clinics and sleep disorders clinics. There is bidirectional
relationship between sleep disorders and psychiatric disorders.
Investigation of the psychiatric dimension of sleep disorders can provide
important information regarding pathophysiology and clinical
management of both psychiatric and sleep disorders. There have been
numerous studies assessing the psychiatric co morbidities and relationship
between sleep disorders and psychiatric disorders. Sleep disorders,
particularly sleep disordered breathing, has been found to be commonly
prevalent in patients of African-American decent. There is no study in
the medical literature evaluating the burden of psychiatric disorders in
African-American patients presenting in sleep disorders clinic. This
study evaluates psychiatric co-morbidities in patients presenting for
evaluation in our sleep disorders clinic
Methods: 1.All African-American patients seen in our sleep disorders
clinic from January 1,2010 till June 30,2010 were identified through
clinic records 2.Chart review of these patients 3.Data were collected
regarding their reasons for referral, demographics, medications, and diagnoses
of various psychiatric disorders as documented in their charts
4.Review of PSG data of patients who underwent sleep studies
Results: All patients who presented to our sleep disorders clinic for
evaluation were included in this review. Mean age was 52.6 years. M:
F ratio was approximately 1:2. Commonly encountered psychiatric
co-morbidities included Major depressive disorder, Anxiety disorders,
Substance abuse, Schizophrenia and Schizoaffective disorders. Snoring,
excessive daytime somnolence and insomnia were the most common
presenting features.Significant number of patients presenting with insomnia
had co-morbid psychiatric disorders.Psychiatric diagnoses were
less common when the results were compred to other similar studies of
general population.
Conclusion: This study showed that significant number of patients presenting
with insomnia had co-morbid psychiatric disorders and suggested
that all patients who present with insomnia should be evaluated for
presence of co-morbid or underlying psychiatric disorders.Psychiatric
disorders in African American patients presenting to our sleep disorders
clinic may be underdiagnosed or less prevelant as comapred to general
population.
0733
THE NIGHTTIME CHAOS OF OEF/OIF MILITARY-RELATED
POSTTRAUMATIC STRESS DISORDER
Nappi CM 1,2 , Salamat J 1 , Anderson D 1 , Norman S 1,2 , Drummond SP 1,2
1
Psychiatry, University of California, San Diego, San Diego, CA, USA,
2
Psychology Service, Veterans Affairs San Diego Healthcare System,
San Diego, CA, USA
Introduction: Subjective sleep disturbances are well documented in
PTSD, although objective sleep problems are less clear. Little data has
been published on sleep characteristics of Operation Enduring Freedom/
Operation Iraqi Freedom (OEF/OIF) Veterans with PTSD. Here, we
present baseline sleep data from OEF/OIF Veterans prior to treatment.
Methods: To be eligible, subjects must have been deployed at least once
to OEF/OIF, experienced a military-related trauma, and meet DSM-IV
criteria for PTSD, chronic insomnia, and nightmare disorder. At baseline,
subjects completed self report questionnaires of sleep, as well as
wore an actigraph and completed sleep diaries for 1 week. We report
data from 21 subjects (age=32.6+/-7.6yrs, 19M, 10 with multiple deployments).
Results: Subjects reported 6.2+/-4.4 nightmares/week, with moderate
levels of associated distress. They scored 9.3+/-3.9 on the PSQI-Addendum,
well above the cutoff of 4. On the CAPS, nightmares were the
most frequent and intense of the reported intrusive symptoms. Global
PSQI scores were significantly elevated (mean=14.2+/-3.2), as were reports
of insomnia on the ISI (mean=18.6+/-3.7) and CAPS (frequency
of sleep difficulty: 100% reported “daily or almost every day”). Diary
data also showed subjectively poor sleep: TST=5.8+/-1.8hrs, SE=77+/-
14%, SL=42+/-8.2min, WASO=68.8+/-56.6min. Actigraphy showed
similar data: TST=6.1+/-1.5hrs, SE=78+/-9.4%, WASO=73+/-28.5min.
Of note, there was considerable inter- and intra-individual variability in
these sleep measures.
Conclusion: Both subjective and objective sleep is highly disturbed in
OEF/OIF Veterans with PTSD and this is the first study to demonstrate
consistency between subjective and objective assessments in this cohort.
As with other PTSD cohorts, nightmares occur almost daily, on average.
Insomnia-related sleep disruptions are seen at levels roughly equivalent
to insomnia patients from our lab and depressed patients in the literature.
Night-to-night variability in sleep, at both group and individual levels,
was greater in PTSD than the other samples. These marked sleep disruptions
may relate to daytime function and/or treatment outcome.
0734
PAP COMPLIANCE IN HISPANIC VETERANS WITH
PSYCHIATRIC DISORDERS
Kovacevic I 1,3 , Wallace DM 1 , Vargas SS 4 , Shafazand S 2
1
Neurology, University of Miami/Miami VA HealthCare System,
Miami, FL, USA, 2 Medicine, Division of Pulmonary, Critical Care,
and Sleep Medicine, University of Miami Miller School of Medicine,
Miami, FL, USA, 3 Psychiatry, University of Miami/Miami VA
HealthCare System, Miami, FL, USA, 4 Medicine, University of Miami
Miller School of Medicine, Miami, FL, USA
Introduction: Psychological symptoms are recognized as contributing
factors in PAP treatment compliance for sleep disordered breathing
(SDB). We explored PAP compliance rates in Hispanic veterans with
and without psychiatric co-morbidities.
Methods: Consecutive Hispanic patients were recruited from the Miami
VA Sleep clinic as part of a sleep education in Hispanics study.
Participants completed questionnaires, screening for SDB, sleep quality
(PSQI), health-related quality of life (HRQOL) and for presence of
anxiety and depression symptoms (HADS). SDB diagnosis and severity
was confirmed by in-lab polysomnography. Patients were categorized in
2 groups (Psychiatric disorders present or not) based on Axis 1 diagnoses
obtained from electronic records. One week after PAP distribution
compliance data was downloaded from PAP memory card. Means and
SDs and frequencies are reported. Group comparisons were made using
Chi-square or student t test as appropriate.
Results: Sixty-one veterans (2% female) were enrolled with mean age
50± 13, BMI of 34±6 and HRQOL score 59.6±21.5. The mean HADS
Depression score was 8±4 and anxiety score 9±5. Axis I diagnosis were
found in 64% of the cohort, 30% had mood disorders, 18% with PTSD,
2% substance abuse, 2% psychoses, and 13% with multiple diagnoses.
Poor sleep quality was reported by 95% of the cohort with mean PSQI
score of 11±4 and 92% screened high risk for SDB and confirmed mean
AHI was 41±32 events per hour. At 7 days, mean total hours of PAP
usage was 30±18. During this time, 35% of the cohort had used PAP
greater than 4 nights, more than 4 hours each night. There was a trend
towards less PAP usage in patients with psychiatric disorders although it
did not reach statistical significance.
Conclusion: Psychiatric disorders may play a role in determining PAP
compliance. Longer term compliance data is needed to confirm this
trend.
SLEEP, Volume 34, Abstract Supplement, 2011
A252