SIMPLE OBJECTIVE SCREENING FOR OBSTRUCTIVE SLEEP APNOEA IN THOSE WITH A SEVERE PSYCHIATRIC ILLNESS.

Abstract

Enduring psychotic illness refers to those people with recurrent psychosis associated with schizophrenia or other psychotic illnesses (1). Those with an enduring psychotic illness are, more often than not, burdened with comorbid cardiometabolic physical health problems. Obstructive sleep apnoea (OSA) is a known risk factor for cardiometabolic disease and requires appropriate screening in those with enduring psychotic illness. Objective screening is the first step in triaging those who may need further investigations, those who need on going monitoring, and those who are not at risk. Improvement in physical health may lead to reduction in the burden of mental illness. OBJECTIVES To examine the potential detriment undiagnosed and untreated OSA has on the physical and mental health of those with enduring psychotic illness. Specifically, to review (i) the problems and gaps in literature associated with the subjective screening for OSA in this population and (ii) the possible OSA objective screening devices that could be used safely in an inpatient population with chronic schizophrenia. The final objective (iii) is to assess the feasibility of a single channel nasal transducer (the Flow Wizard) as an objective-screening tool for OSA in an inpatient population with a diagnosis of chronic schizophrenia. METHOD (LITERATURE REVIEW) A literature search using the PubMed ⁄ Medline database (2000- 2017) was under taken. The main search terms were schizophrenia, psychosis, obstructive sleep apnoea, and weight- gain. Search terms also included the following assessment tools for OSA: The STOP-Bang, the Flow Wizard and the Wrist Ox. CONCLUSION (LITERATURE SEARCH) The literature review found a paucity of studies on OSA in those with enduring psychotic illness. Currently, only a few studies have used simple objective screening tools to assess for OSA in inpatient populations with psychosis. No studies have trialled the use of the Flow Wizard in this population. METHODS (STUDY) A pilot study was undertaken to assess the feasibility of the Flow Wizard as a screening tool for OSA in an inpatient psychiatric population. Between 2014 and 2016, 31 inpatients with a diagnosis of schizophrenia at Concord Centre for Mental Health were asked to participate in the study. Anthropometric assessments assessed on the day of the study and cardiovascular risk profiles were collected as close as practical to the night the Flow Wizard screening took place. RESULTS AND CONCLUSION OF THE STUDY The participation rate of this study was poor as 52% of suitable participants refused to trial the study device. Non-acceptance of the device was mainly related to the invasive nature of the tubing around the face. However, 73% of inpatients who trialled the device produced adequate nasal flow data over one 4 night. Due to the small sample size no trends were found between the apnoea - hypopnoea index (AHI) and all other metabolic variables. While the use of the Flow Wizard is technically possible in some patients as a screening device, overall it is probably not feasible in those inpatients with chronic schizophrenia. The invasive nature of the tubing around the face in this population needs to be considered. It is expected that a less invasive device maybe more readily accepted by inpatients with chronic schizophrenia.