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Schizophrenia, Hypoxemia or both: a Case Report
Schizophrenia is a serious mental disorder characterized by distortions of thought and perception. The difficulty in achieving or maintaining restful sleep is a relevant symptom of this condition, in which a decrease on the duration and quality of REM sleep is commonly seen. Other sleep disorders can worsen schizophrenic symptoms. The current literature shows that Obstructive Sleep Apnea (OSA) is twice as frequent among schizophrenics than in general population. Animal studies showed that repetitive intermittent hypoxemia have an impact on dysfunction-dysregulation of dopaminergic and glutamate pathways in the striatum, mesolimbic area and pre-frontal cortex, and a few cases of improvement in schizophrenic symptoms after treatment of OSA have been reported.
To illustrate with a case report the benefit of OSA treatment in schizophrenic patients.
After obtaining patient’s consent, the case description was made by reviewing medical records.
Male, 28 years, went through surgery to correct an Atrial Sept Defect in 1995 and has a mild mitral regurgitation since childhood was diagnosed with schizophrenia at 19 years old after he began to have visual and auditory hallucinations related to violent behavior. In use of Olanzapine and Clonazepam, he had already had aspiration pneumonia. Hospitalized with severe hypoxemia due to decompensated Primary Pulmonary Hypertension (PPH). Admission arterial gasometry: pH: 7,314; pCO2: 33,80mmHg; pO2: 41,80mmHg; HCO3: 17,20; O2 saturation: 73,50%. After cardio-pulmonary stabilization, was discharged and referred to sleep specialist due to poor sleep quality, many awakenings, difficulty sleeping lying down and excessive daytime sleepiness. Polysomnography was performed, which found: REM sleep latency of 303 minutes, 5,8% of REM sleep, 99,8 awakenings per hour, apnea-hypopnea index (AHI) 88/hour, basal oxyhemoglobin saturation of 95%, with the average saturation 84% and minimum 74%, remaining 99,4% of the recording time with saturation below 90%. After initiation of treatment with BiPAP and hypoxemia improvement (post-treatment AHI: 3,3/hour) there was a significant improvement in schizophrenic symptoms, without hallucinations since 2017, but PPH difficult to control.
This case illustrates the association between severe Obstructive Sleep Apnea and schizophrenic patient that has benefit of psychiatric condition and quality of life after OSA treatment.
Obstructive Sleep Apnea, Schizophrenia, Hypoxemia
Relato de Caso
Centro Universitário FAG - Parana - Brasil
Ana Carolina De Quadros, Carolina Ferraz de Paula Soares, Laura Prado Godoy, Luana Priscila Bamberg Schenider, Isabela Resende Farias, Pedro de Mello Rego Lopes, Leticia Rubert, Andrey Felipe de Carvalho Pinheiro, Julia de Paula Cordeiro, Marithza Mayumi Hata