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REM sleep suppression in patients with obstructive sleep apnea: Effects of REM suppressing medication
P.6. Other topics the dimension 'Depression' of the EQ-5D (p < 0.01). Results on the analyses of other psychometric variables were the following: 1) internal consistency (Cronbach's ct): HARS 0.89 (n = 102), MADRS 0.88 (n = 108); 2) test-retest reliability (ICC): HARS 0.92 (n = 50), MADRS 0.94 (n = 47); 3) inter-rating reliability (ICC): HARS 0.92 (n = 22), MADRS 0.98 (n = 22); and, 4) Sensitivity to change (ES): HARS 1.36 (n = 49), MADRS 2.05 (n = 54). Conclusion: The Spanish versions of the HARS and MADRS have shown adequate validity and reproducibility for use in clinical research and in the clinical assessment of patients with anxiety and depressive disorders, respectively.
IP.6.022[
Request of psychiatric aid in ischemic heart disease and major depressive disorder
C. Castro-Dono, F. Iglesias Gil de Bernabr, J. Alberdi Sudupe, L. Ferrer i Balsebre. Psychiatry Service, Hospital Juan Canalejo,
La Coru~a, Spain Objectives: To determine the frequency of psychiatric consultations and the kind of prestations from them derived and given to patients who are under treatment for their ischemic heart disease and have been diagnosed of concurrent major depression. Method: We are studying a sample of 174 patients with ischemic heart disease diagnosis and cardiac catheterization, successively hospitalised at the cardiology floor of the Hospital Juan Canalejo in Spain, from the first of May until October the 31 st (six months), 1997. It is a prospective and observational study, for which we arranged a basal assessment and a final one six months later. Tests used: Social Demographic Questionnaire, Cardio-Psychiatric Questionnaire, Beck Depression Inventory and Major Depressive Disorder according to DSM-IV criteria. Results: From the whole sample, there are a total of 36 patients (20.7%) with Major Depressive disorder after six months of complimenting or commencing cardiological treatment. From those, only two (5.6%) went through at least one psychiatric consultation during this period. Conclusion: It is concluded that the patients with Major Depressive disorder under cardiological treatment for their ischemic heart disease, do not frequent or request psychiatric consultation. This result suggests that major depression in ischemic heart disease under treatment is an infradiagnosed and unsuitably treated pathology.
References [1] Dwight MM, StoudemireA. Effects of depressivedisorders on coronary artery disease: a review. Harv Rev Psychiatry 1997; 5 (3): 115-122. [2] Musselman DL, Evans DL, Nemeroff CB. The relationship of depression to cardiovascular disease: epidemiology,biology, and treatment. Arch Gen Psychiatry 1998 Jul; 55 (7): 580-592. [3] Beck AT, Ward CH, Mendelson M. An inventory for measuring depression. Arch Gen Psychiatry 1961; 4: 561-571.
~ R E M sleep suppression in patients with obstructive sleep apnea: Effects of REM suppressing medication A.S. Baran, A.C. Richert, K. Ansarin, H.P. Roffwarg, A. Halaris. University of Mississippi Medical Center, Department of
$347
sleep disorder, causes sleep disruption that may suppress REM sleep. We examined REM sleep suppression in two groups of patients with OSA, one that is and one that is not also taking REM-suppressing medications. Methods: Diagnostic polysomnograrns performed at the University of Mississippi Medical Center between 1/3/1999 and 1/3/2001 were selected based on the following criteria: 1) moderate to severe OSA (apnea-hypopnea index of 15/hour or greater), 2) REM sleep less than 20% of total sleep time, and 3) periodic limb movement (PLM) index less than 10/hour. Subjects with mild apnea were not included due to the typical coexistence of upper airway resistance syndrome, a milder variant of OSA, which is not reflected in the apnea-hypopnea index (AHI). Subjects with a PLM index > 10/hour were not included since this would have introduced a second and uncontrolled source of sleep disruption. Subjects were divided into 2 groups: Group M was comprised of patients taking REM-suppressing medications and Group NM contained patients who were not taking REM suppressants. The medications consisted of agents known to suppress REM sleep, including tricyclic antidepressants, serotonin-selective-reuptakeinhibitors, monoamine oxidase inhibitors, and in a minority of cases, barbiturates. In each group, the effect of OSA severity (as determined by the AHI; moderate OSA defined as AHI < 40/hour and severe OSA as AHI > 40/hour) in elation to REM sleep percentage was analyzed. Results: Of 1025 sequential polysomnograms, 197 meeting the above criteria were selected. Due to non-normal distribution of the data, the Mann-Whitney Rank Sum test was used for comparisons. In the entire sample of subjects, REM sleep percentage tended to be lower in subjects with AHI > 40/hour (median = 11.3 [25%-75% = 7.1-16.4]) compared to subjects with AHI < 40/hour (median = 13.0 [25%,75% = 7.4-16.9]), which was not statistically significant (p = 0.16). In Group M (61 subjects; mean age = 64.6), REM sleep percentage was lower (p = 0.01) in subjects with AHI > 40/hour (median = 5.8 [25%,75% = 1.110.4]) compared to subjects with AHI < 40/hour (median = 11.1 [25%-75% = 6.9-14.7]). In Group NM (136 subjects; mean age = 42.7), there was no significant difference (p = 0.57) in REM sleep percentage between the subgoups of patients with AHI > 40/hour (median = 13.5% [25%-75% = 8.1-17.7]) and patients with AHI < 40/hour (median = 13.3 [25%,75% = 8.4-16.7]). Conclusion: In patients with OSA who had diminished REM sleep, the severity of OSA as determined by AHI sigrtificantly affected the degree of REM sleep suppression only in patients taking REM sleep-suppressing medications. This suggests a synergistic suppressive effect of OSA and REM suppressing medications on REM sleep percentage. Although REM sleep percentage is thought to be preserved in normal advanced-age individuals, the age difference between the groups may have accounted for increased susceptibility to sleep fragmentation by either or both OSA and medications.
[P.6.0241 Milnacipran in the treatment of bulimia: A report of 16 cases
N. EI-Giamal, M. De Zwaan, U. Bailer, A. Strnad, E Schiissler, S. Kasper. Department of General Psychiatry, University Hospital
of Psychiatry, Vienna, Austria
Psychiatry, Jackson, Mississippi, USA Introduction: Certain medications, including antidepressants, suppress REM sleep. Obstructive sleep apnea (OSA), a common
Controlled trials in patients with bulimia nervosa have demonstrated therapeutic responses to antidepressant medications with serotonergic function (eg, fluoxetine) as well as noradrenergic
IP.6.022[
Request of psychiatric aid in ischemic heart disease and major depressive disorder
C. Castro-Dono, F. Iglesias Gil de Bernabr, J. Alberdi Sudupe, L. Ferrer i Balsebre. Psychiatry Service, Hospital Juan Canalejo,
La Coru~a, Spain Objectives: To determine the frequency of psychiatric consultations and the kind of prestations from them derived and given to patients who are under treatment for their ischemic heart disease and have been diagnosed of concurrent major depression. Method: We are studying a sample of 174 patients with ischemic heart disease diagnosis and cardiac catheterization, successively hospitalised at the cardiology floor of the Hospital Juan Canalejo in Spain, from the first of May until October the 31 st (six months), 1997. It is a prospective and observational study, for which we arranged a basal assessment and a final one six months later. Tests used: Social Demographic Questionnaire, Cardio-Psychiatric Questionnaire, Beck Depression Inventory and Major Depressive Disorder according to DSM-IV criteria. Results: From the whole sample, there are a total of 36 patients (20.7%) with Major Depressive disorder after six months of complimenting or commencing cardiological treatment. From those, only two (5.6%) went through at least one psychiatric consultation during this period. Conclusion: It is concluded that the patients with Major Depressive disorder under cardiological treatment for their ischemic heart disease, do not frequent or request psychiatric consultation. This result suggests that major depression in ischemic heart disease under treatment is an infradiagnosed and unsuitably treated pathology.
References [1] Dwight MM, StoudemireA. Effects of depressivedisorders on coronary artery disease: a review. Harv Rev Psychiatry 1997; 5 (3): 115-122. [2] Musselman DL, Evans DL, Nemeroff CB. The relationship of depression to cardiovascular disease: epidemiology,biology, and treatment. Arch Gen Psychiatry 1998 Jul; 55 (7): 580-592. [3] Beck AT, Ward CH, Mendelson M. An inventory for measuring depression. Arch Gen Psychiatry 1961; 4: 561-571.
~ R E M sleep suppression in patients with obstructive sleep apnea: Effects of REM suppressing medication A.S. Baran, A.C. Richert, K. Ansarin, H.P. Roffwarg, A. Halaris. University of Mississippi Medical Center, Department of
$347
sleep disorder, causes sleep disruption that may suppress REM sleep. We examined REM sleep suppression in two groups of patients with OSA, one that is and one that is not also taking REM-suppressing medications. Methods: Diagnostic polysomnograrns performed at the University of Mississippi Medical Center between 1/3/1999 and 1/3/2001 were selected based on the following criteria: 1) moderate to severe OSA (apnea-hypopnea index of 15/hour or greater), 2) REM sleep less than 20% of total sleep time, and 3) periodic limb movement (PLM) index less than 10/hour. Subjects with mild apnea were not included due to the typical coexistence of upper airway resistance syndrome, a milder variant of OSA, which is not reflected in the apnea-hypopnea index (AHI). Subjects with a PLM index > 10/hour were not included since this would have introduced a second and uncontrolled source of sleep disruption. Subjects were divided into 2 groups: Group M was comprised of patients taking REM-suppressing medications and Group NM contained patients who were not taking REM suppressants. The medications consisted of agents known to suppress REM sleep, including tricyclic antidepressants, serotonin-selective-reuptakeinhibitors, monoamine oxidase inhibitors, and in a minority of cases, barbiturates. In each group, the effect of OSA severity (as determined by the AHI; moderate OSA defined as AHI < 40/hour and severe OSA as AHI > 40/hour) in elation to REM sleep percentage was analyzed. Results: Of 1025 sequential polysomnograms, 197 meeting the above criteria were selected. Due to non-normal distribution of the data, the Mann-Whitney Rank Sum test was used for comparisons. In the entire sample of subjects, REM sleep percentage tended to be lower in subjects with AHI > 40/hour (median = 11.3 [25%-75% = 7.1-16.4]) compared to subjects with AHI < 40/hour (median = 13.0 [25%,75% = 7.4-16.9]), which was not statistically significant (p = 0.16). In Group M (61 subjects; mean age = 64.6), REM sleep percentage was lower (p = 0.01) in subjects with AHI > 40/hour (median = 5.8 [25%,75% = 1.110.4]) compared to subjects with AHI < 40/hour (median = 11.1 [25%-75% = 6.9-14.7]). In Group NM (136 subjects; mean age = 42.7), there was no significant difference (p = 0.57) in REM sleep percentage between the subgoups of patients with AHI > 40/hour (median = 13.5% [25%-75% = 8.1-17.7]) and patients with AHI < 40/hour (median = 13.3 [25%,75% = 8.4-16.7]). Conclusion: In patients with OSA who had diminished REM sleep, the severity of OSA as determined by AHI sigrtificantly affected the degree of REM sleep suppression only in patients taking REM sleep-suppressing medications. This suggests a synergistic suppressive effect of OSA and REM suppressing medications on REM sleep percentage. Although REM sleep percentage is thought to be preserved in normal advanced-age individuals, the age difference between the groups may have accounted for increased susceptibility to sleep fragmentation by either or both OSA and medications.
[P.6.0241 Milnacipran in the treatment of bulimia: A report of 16 cases
N. EI-Giamal, M. De Zwaan, U. Bailer, A. Strnad, E Schiissler, S. Kasper. Department of General Psychiatry, University Hospital
of Psychiatry, Vienna, Austria
Psychiatry, Jackson, Mississippi, USA Introduction: Certain medications, including antidepressants, suppress REM sleep. Obstructive sleep apnea (OSA), a common
Controlled trials in patients with bulimia nervosa have demonstrated therapeutic responses to antidepressant medications with serotonergic function (eg, fluoxetine) as well as noradrenergic