Posters
Academic Level (Author 1)
Medical Student
Discipline/Specialty (Author 1)
Psychiatry
Academic Level (Author 2)
Medical Student
Discipline/Specialty (Author 2)
Psychiatry
Academic Level (Author 3)
Faculty
Discipline/Specialty (Author 3)
Psychiatry
Discipline Track
Clinical Science
Abstract
Background: The comorbidity of mood disorders and Upper Airway Resistance Syndrome (UARS) presents a significant challenge, especially in pediatric populations. UARS, characterized by increased upper airway resistance during sleep, often leads to disrupted sleep and daytime symptoms such as fatigue and cognitive impairment. Studies estimate UARS affects 15-30% of patients undergoing polysomnography for suspected sleep-disordered breathing. Mood & Anxiety Disorders are prevalent in patients with sleep-disordered breathing, with higher rates than in the general population.
Case Presentation: 16-year-old female, with psychiatric history of Bipolar II Disorder current episode depressed, ADHD, and Other Specified Anxiety Disorder presents for a follow-up. Since 2021, despite several trails of medical management, patient continues to experience significant anxiety and reports suboptimal control of her mood symptoms, including low energy & concentration, psychomotor retardation, and guilt. Current PHQ-9 and GAD-7 are 10 and 11 respectively with an average score history (2021-2023) of ~20 and 23 respectively.
Throughout her visits, patient voiced difficulty sleeping despite trials of clonidine and trazadone. Recent sleep medicine consult reported chronic sleep onset and maintenance insomnia since age 12, fragmented sleep despite consistent bedtime routine, restless legs syndrome, and upper airway resistance syndrome with no significant apnea-hypopnea events (diagnosed via an in-laboratory diagnostic polysomnogram). Pregabalin was prescribed for restless legs and a trial of auto-CPAP was suggested for UARS. Emphasis was placed on weight loss and maintaining sleep hygiene. Currently, the patient is using a CPAP machine for UARS, which contributed to some improvement in sleep quality.
Discussion: The interplay between UARS and mood disorders is evident in this case, highlighting the need for integrated treatment approaches. UARS can exacerbate mood symptoms through sleep fragmentation, leading to a cyclical pattern of poor sleep and mood instability. Effective management of UARS with a CPAP machine appeared to stabilize mood and improve sleep quality, although residual symptoms of low energy and concentration persisted.
Effective management strategies for UARS include CPAP, but can be challenging for some patients to tolerate. Alternative treatments include oral appliances designed to reposition the mandible and tongue, thus relieving pharyngeal obstruction during sleep. Behavioral measures, including sleep hygiene and cognitive-behavioral therapy, are essential components of managing UARS and associated mood disorders.
Surgical interventions, though not the first line of treatment, can be considered for certain patients. Surgical options such as tonsillectomy and adenoidectomy, uvulopalatopharyngoplasty, and rapid palatal expansion have shown success in improving airway patency and reducing symptoms of UARS. Rapid palatal expansion, for instance, has been documented to significantly improve symptoms and overall quality of life in patients with UARS, leading to better sleep and mood regulation.
Diagnosis and treatment of UARS in the context of depressed mood can be complicated by the overlap of symptoms including sleep and fatigue. It’s estimated that up to 40% of patients with depressed mood may have underlying UARS contributing to their symptoms. This case underscores the importance of a multidisciplinary approach, combining sleep management with psychiatric care to optimize outcomes for patients with comorbid conditions.
Presentation Type
Poster
Recommended Citation
Pokhrel, Abhishekh; Zarate, Alexa Lissete; and Amador, Alcides, "Comorbidity of Mood Disorders and Upper airway Resistance Syndrome: A Case Report" (2024). Research Colloquium. 82.
https://scholarworks.utrgv.edu/colloquium/2024/posters/82
Included in
Circulatory and Respiratory Physiology Commons, Psychiatric and Mental Health Commons, Psychiatry Commons, Pulmonology Commons
Comorbidity of Mood Disorders and Upper airway Resistance Syndrome: A Case Report
Background: The comorbidity of mood disorders and Upper Airway Resistance Syndrome (UARS) presents a significant challenge, especially in pediatric populations. UARS, characterized by increased upper airway resistance during sleep, often leads to disrupted sleep and daytime symptoms such as fatigue and cognitive impairment. Studies estimate UARS affects 15-30% of patients undergoing polysomnography for suspected sleep-disordered breathing. Mood & Anxiety Disorders are prevalent in patients with sleep-disordered breathing, with higher rates than in the general population.
Case Presentation: 16-year-old female, with psychiatric history of Bipolar II Disorder current episode depressed, ADHD, and Other Specified Anxiety Disorder presents for a follow-up. Since 2021, despite several trails of medical management, patient continues to experience significant anxiety and reports suboptimal control of her mood symptoms, including low energy & concentration, psychomotor retardation, and guilt. Current PHQ-9 and GAD-7 are 10 and 11 respectively with an average score history (2021-2023) of ~20 and 23 respectively.
Throughout her visits, patient voiced difficulty sleeping despite trials of clonidine and trazadone. Recent sleep medicine consult reported chronic sleep onset and maintenance insomnia since age 12, fragmented sleep despite consistent bedtime routine, restless legs syndrome, and upper airway resistance syndrome with no significant apnea-hypopnea events (diagnosed via an in-laboratory diagnostic polysomnogram). Pregabalin was prescribed for restless legs and a trial of auto-CPAP was suggested for UARS. Emphasis was placed on weight loss and maintaining sleep hygiene. Currently, the patient is using a CPAP machine for UARS, which contributed to some improvement in sleep quality.
Discussion: The interplay between UARS and mood disorders is evident in this case, highlighting the need for integrated treatment approaches. UARS can exacerbate mood symptoms through sleep fragmentation, leading to a cyclical pattern of poor sleep and mood instability. Effective management of UARS with a CPAP machine appeared to stabilize mood and improve sleep quality, although residual symptoms of low energy and concentration persisted.
Effective management strategies for UARS include CPAP, but can be challenging for some patients to tolerate. Alternative treatments include oral appliances designed to reposition the mandible and tongue, thus relieving pharyngeal obstruction during sleep. Behavioral measures, including sleep hygiene and cognitive-behavioral therapy, are essential components of managing UARS and associated mood disorders.
Surgical interventions, though not the first line of treatment, can be considered for certain patients. Surgical options such as tonsillectomy and adenoidectomy, uvulopalatopharyngoplasty, and rapid palatal expansion have shown success in improving airway patency and reducing symptoms of UARS. Rapid palatal expansion, for instance, has been documented to significantly improve symptoms and overall quality of life in patients with UARS, leading to better sleep and mood regulation.
Diagnosis and treatment of UARS in the context of depressed mood can be complicated by the overlap of symptoms including sleep and fatigue. It’s estimated that up to 40% of patients with depressed mood may have underlying UARS contributing to their symptoms. This case underscores the importance of a multidisciplinary approach, combining sleep management with psychiatric care to optimize outcomes for patients with comorbid conditions.