Sleep-disordered breathing in severe mental illness: clinical evaluation of oximetry diagnosis and management limitation
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SLEEP BREATHING PHYSIOLOGY AND DISORDERS • ORIGINAL ARTICLE
Sleep-disordered breathing in severe mental illness: clinical evaluation of oximetry diagnosis and management limitations P. Espinel 1,2 & N. Marshall 1,3 & B. J. Yee 1,4,5 & J. Hollis 2 & K. Smith 2,6 & A. L. D’Rozario 1,5,7 & G. Gauthier 4 & T. Lambert 2,6,8 & R. R. Grunstein 1,5,8 Received: 13 August 2020 / Revised: 8 November 2020 / Accepted: 18 November 2020 # Springer Nature Switzerland AG 2020
Abstract Background To describe the diagnosis and management pathway of sleep-disordered breathing (SDB) in a sample of patients with severe mental illness (SMI), and to assess the feasibility and patient acceptability of overnight oximetry as a first-step screening method for detecting severe SDB in this population. Methods The study was a retrospective audit of patients with SMI seen at a Collaborative Centre for Cardiometabolic Health in Psychosis service who were invited for overnight oximetry between November 2015 and May 2018. The adjusted oxygen desaturation index (ODI) was calculated using 4% desaturation criteria. Results were discussed with a sleep specialist and categorized into a 4-level risk probability tool for SDB. Results Of 91 adults consenting for overnight oximetry, 90 collected some oximetry data, though 11 of these 90 patients collected technically unsatisfactory oximetry. Thus 79/90 patients (88%) collected adequate oximetry data for at least one night. The oximetry traces suggested likely minimal obstructive sleep apnea (OSA) in 41 cases, moderate to severe OSA in 25 patients, severe OSA in 9 patients and possible obesity hypoventilation syndrome (OHS) in 4 cases. Full polysomnography was recommended for 39 patients but only one-third underwent testing. Nineteen patients were reviewed by a sleep specialist. Of the 10 patients who initiated CPAP, four were considered adherent to treatment. Conclusion Home oximetry may be a pragmatic option for SDB screening in patients with SMI but reliable full diagnostic and management pathways need to be developed. Keywords Obstructive sleep apnea . Sleep-disordered breathing . Clinical audit . Schizophrenia . Severe mental illness . Oximetry
Lambert T and Grunstein RR are senior authors. * R. R. Grunstein [email protected]
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Faculty of Medicine and Health, The University of Sydney, Sydney, NSW 2006, Australia
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CIRUS, Centre for Sleep and Chronobiology - NHMRC Centre of Research Excellence, Woolcock Institute of Medical Research, Level 4, 431 Glebe Point Road, Glebe, NSW 2018, Australia
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Concord Clinical School, Medical Education Centre, Concord Repatriation General Hospital, Hospital Road, Concord, NSW 2139, Australia
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Collaborative Centre for Cardiometabolic Health in Psychosis Sydney Local Health District, Ground Floor, Clinical Sciences Building, Hospital Road, Concord, NSW 2139, Australia
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School of Psychology, Faculty of Science, Brain and Mind Centre and Charles Perkins Centre, The University of Sydney, Sydney, NSW, Australia
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RPA-Charles Perkins Centre, Royal Princ
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