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METHODS ASSOCIATIONS BETWEEN OSA AND PSYCHIATRIC DISORDERS CLINICAL IMPLICATIONS OF OSA IN PATIENTS WITH PSYCHIATRIC DISORDERS RECOGNIZING OSA IN PATIENTS WITH PSYCHIATRIC DISORDERS MANAGING PATIENTS WITH PSYCHIATRIC DISORDERS WHO HAVE COMORBID OSA LIMITATIONS CONCLUSIONS CLINICAL POINTS
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Systematic Review January 23, 2023

Recognition and Management of Obstructive Sleep Apnea in Psychiatric Practice

Ruth M. Benca, MD, PhD; Andrew Krystal, MD; Craig Chepke, MD, FAPA; Karl Doghramji, MD

J Clin Psychiatry 2023;84(2):22r14521

ABSTRACT

Objective: The aims of this review were to describe the relationship between obstructive sleep apnea (OSA) and psychiatric disorders and provide an overview of how to recognize/manage OSA in psychiatric practice.

Data Sources: A literature search of PubMed was conducted (in adults, English language, no limitation on year). Among others, main keywords included “obstructive sleep apnea” AND “psychiatric.”

Study Selection: Articles relevant to the treatment of OSA in psychiatric populations were selected manually.

Data Extraction: No formal data charting was conducted.

Results: A total of 141 articles were included from the literature search. Comorbid OSA is common among patients with psychiatric disorders, particularly depression and posttraumatic stress disorder. Evidence suggests that OSA may be an independent risk factor for the development of psychiatric conditions, as well as for suicidal ideation and attempts in psychiatric populations. Recognizing OSA in patients with psychiatric disorders can be challenging due to the overlap of symptoms (eg, sleep issues, mood changes, and vegetative symptoms) between OSA, psychiatric disorders, and side effects of psychiatric medications. Inadequately treated OSA can affect the severity of psychiatric symptoms and impair response to psychiatric treatment.

Conclusions: Clinicians should not assume that all sleep-related symptoms are consequences of psychiatric illness or medication but should instead be cognizant of the potential for coexisting OSA that requires treatment. Recognizing and managing OSA in patients with psychiatric disorders are critical to improve response to treatment, quality of life, and overall health.

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  1. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders: DSM-5. 5th ed. American Psychiatric Publishing; 2013.
  2. American Academy of Sleep Medicine. International Classification of Sleep Disorders. 3rd ed. American Academy of Sleep Medicine; 2014.
  3. Waterman L, Stahl ST, Buysse DJ, et al. Self-reported obstructive sleep apnea is associated with nonresponse to antidepressant pharmacotherapy in late-life depression. Depress Anxiety. 2016;33(12):1107–1113. PubMed CrossRef
  4. Benjafield AV, Ayas NT, Eastwood PR, et al. Estimation of the global prevalence and burden of obstructive sleep apnoea: a literature-based analysis. Lancet Respir Med. 2019;7(8):687–698. PubMed CrossRef
  5. Hombali A, Seow E, Yuan Q, et al. Prevalence and correlates of sleep disorder symptoms in psychiatric disorders. Psychiatry Res. 2019;279:116–122. PubMed CrossRef
  6. McCall WV, Benca RM, Rumble ME, et al. Prevalence of obstructive sleep apnea in suicidal patients with major depressive disorder. J Psychiatr Res. 2019;116:147–150. PubMed CrossRef
  7. Stubbs B, Vancampfort D, Veronese N, et al. The prevalence and predictors of obstructive sleep apnea in major depressive disorder, bipolar disorder and schizophrenia: a systematic review and meta-analysis. J Affect Disord. 2016;197:259–267. PubMed CrossRef
  8. Talih FR, Ajaltouni JJ, Tamim HM, et al. Risk of obstructive sleep apnea and excessive daytime sleepiness in hospitalized psychiatric patients. Neuropsychiatr Dis Treat. 2017;13:1193–1200. PubMed CrossRef
  9. Aftab Z, Anthony AT, Rahmat S, et al. An updated review on the relationship of depressive symptoms in obstructive sleep apnea and continuous positive airway pressure. Cureus. 2021;13(6):e15907. PubMed CrossRef
  10. Edwards C, Mukherjee S, Simpson L, et al. Depressive symptoms before and after treatment of obstructive sleep apnea in men and women. J Clin Sleep Med. 2015;11(9):1029–1038. PubMed CrossRef
  11. Zheng D, Xu Y, You S, et al. Effects of continuous positive airway pressure on depression and anxiety symptoms in patients with obstructive sleep apnoea: results from the sleep apnoea cardiovascular endpoint randomised trial and meta-analysis. EClinicalMedicine. 2019;11:89–96. PubMed CrossRef
  12. El-Solh AA, Homish GG, Ditursi G, et al. A randomized crossover trial evaluating continuous positive airway pressure versus mandibular advancement device on health outcomes in veterans with posttraumatic stress disorder. J Clin Sleep Med. 2017;13(11):1327–1335. PubMed CrossRef
  13. Mysliwiec V, Capaldi VF 2nd, Gill J, et al. Adherence to positive airway pressure therapy in US military personnel with sleep apnea improves sleepiness, sleep quality, and depressive symptoms. Mil Med. 2015;180(4):475–482. PubMed CrossRef
  14. Roest AM, Carney RM, Stein PK, et al. Obstructive sleep apnea/hypopnea syndrome and poor response to sertraline in patients with coronary heart disease. J Clin Psychiatry. 2012;73(1):31–36. PubMed CrossRef
  15. Practice Guideline for the Treatment of Patients With Major Depressive Disorder, Third Edition. American Psychiatric Association; 2010.
  16. Reddy A, Mansuri Z, Vadukapuram R, et al. Increased suicidality and worse outcomes in MDD patients with OSA: a nationwide inpatient analysis of 11 years from 2006 to 2017. J Acad Consult Liaison Psychiatry. 2022;63(1):46–52. PubMed CrossRef
  17. Peppard PE, Young T, Barnet JH, et al. Increased prevalence of sleep-disordered breathing in adults. Am J Epidemiol. 2013;177(9):1006–1014. PubMed CrossRef
  18. Gupta MA, Simpson FC. Obstructive sleep apnea and psychiatric disorders: a systematic review. J Clin Sleep Med. 2015;11(2):165–175. PubMed CrossRef
  19. Hein M, Lanquart JP, Loas G, et al. Prevalence and risk factors of moderate to severe obstructive sleep apnea syndrome in major depression: a observational and retrospective study on 703 subjects. BMC Pulm Med. 2017;17(1):165. PubMed CrossRef
  20. Sharafkhaneh A, Giray N, Richardson P, et al. Association of psychiatric disorders and sleep apnea in a large cohort. Sleep. 2005;28(11):1405–1411. PubMed CrossRef
  21. Zhang Y, Weed JG, Ren R, et al. Prevalence of obstructive sleep apnea in patients with posttraumatic stress disorder and its impact on adherence to continuous positive airway pressure therapy: a meta-analysis. Sleep Med. 2017;36:125–132. PubMed CrossRef
  22. Tanielian M, Doghramji K, Certa K. Obstructive sleep apnea in psychiatric inpatients. J Nerv Ment Dis. 2020;208(3):190–193. PubMed CrossRef
  23. Fehr BS, Katz WF, Van Enkevort EA, et al. Obstructive sleep apnea in posttraumatic stress disorder comorbid with mood disorder: significantly higher incidence than in either diagnosis alone. Prim Care Companion CNS Disord. 2018;20(4):18m02281. PubMed CrossRef
  24. Colvonen PJ, Masino T, Drummond SP, et al. Obstructive sleep apnea and posttraumatic stress disorder among OEF/OIF/OND veterans. J Clin Sleep Med. 2015;11(5):513–518. PubMed CrossRef
  25. Haddad JM, Chen ES. Identifying psychiatric comorbidities for obstructive sleep apnea in the Biomedical Literature and Electronic Health Record. AMIA Jt Summits Transl Sci Proc. 2017;2017:502–511. PubMed
  26. Ohayon MM. The effects of breathing-related sleep disorders on mood disturbances in the general population. J Clin Psychiatry. 2003;64(10):1195–1200, quiz, 1274–1276. PubMed CrossRef
  27. Lu MK, Tan HP, Tsai IN, et al. Sleep apnea is associated with an increased risk of mood disorders: a population-based cohort study. Sleep Breath. 2017;21(2):243–253. PubMed CrossRef
  28. Kim JY, Ko I, Kim DK. Association of obstructive sleep apnea with the risk of affective disorders. JAMA Otolaryngol Head Neck Surg. 2019;145(11):1020–1026. PubMed CrossRef
  29. Chang WP, Liu ME, Chang WC, et al. Sleep apnea and the risk of dementia: a population-based 5-year follow-up study in Taiwan. PLoS One. 2013;8(10):e78655. PubMed CrossRef
  30. Peppard PE, Szklo-Coxe M, Hla KM, et al. Longitudinal association of sleep-related breathing disorder and depression. Arch Intern Med. 2006;166(16):1709–1715. PubMed CrossRef
  31. LaGrotte C, Fernandez-Mendoza J, Calhoun SL, et al. The relative association of obstructive sleep apnea, obesity and excessive daytime sleepiness with incident depression: a longitudinal, population-based study. Int J Obes (Lond). 2016;40(9):1397–1404. PubMed CrossRef
  32. Sweetman A, Lack L, McEvoy RD, et al. Bi-directional relationships between co-morbid insomnia and sleep apnea (COMISA). Sleep Med Rev. 2021;60:101519. PubMed CrossRef
  33. Luyster FS, Buysse DJ, Strollo PJ Jr. Comorbid insomnia and obstructive sleep apnea: challenges for clinical practice and research. J Clin Sleep Med. 2010;6(2):196–204. PubMed CrossRef
  34. Krell SB, Kapur VK. Insomnia complaints in patients evaluated for obstructive sleep apnea. Sleep Breath. 2005;9(3):104–110. PubMed CrossRef
  35. Hamilton M. A rating scale for depression. J Neurol Neurosurg Psychiatry 1960;23:56–62. https://dcf.psychiatry.ufl.edu/files/2011/05/HAMILTON-DEPRESSION.pdf
  36. Williams JB, Kobak KA. Development and reliability of a structured interview guide for the Montgomery Asberg Depression Rating Scale (SIGMA). Br J Psychiatry. 2008;192(1):52–58. PubMed CrossRef
  37. Kroenke K, Spitzer RL, Williams JB. The PHQ-9: validity of a brief depression severity measure. J Gen Intern Med. 2001;16(9):606–613. PubMed CrossRef
  38. McNair D, Lorr M, Droppleman LF. Manual for the Profile of Mood States. Educational and Industrial Testing Service; 1971. https://www.brianmac.co.uk/poms.htm
  39. Beck AT, Ward CH, Mendelson M, et al. An inventory for measuring depression. Arch Gen Psychiatry. 1961;4(6):561–571. PubMed CrossRef
  40. Aikens JE, Caruana-Montaldo B, Vanable PA, et al. MMPI correlates of sleep and respiratory disturbance in obstructive sleep apnea. Sleep. 1999;22(3):362–369. PubMed CrossRef
  41. Karamanlı H, Kayhan F, Akgedik R. Depressive symptoms in patients with obstructive sleep apnea. Turk Thorac J. 2016;17(3):109–113. PubMed CrossRef
  42. Krakow B, Melendrez D, Johnston L, et al. Sleep-disordered breathing, psychiatric distress, and quality of life impairment in sexual assault survivors. J Nerv Ment Dis. 2002;190(7):442–452. PubMed CrossRef
  43. Heck T, Zolezzi M. Obstructive sleep apnea: management considerations in psychiatric patients. Neuropsychiatr Dis Treat. 2015;11:2691–2698. PubMed
  44. El-Solh AA, Vermont L, Homish GG, et al. The effect of continuous positive airway pressure on post-traumatic stress disorder symptoms in veterans with post-traumatic stress disorder and obstructive sleep apnea: a prospective study. Sleep Med. 2017;33:145–150. PubMed CrossRef
  45. Povitz M, Bolo CE, Heitman SJ, et al. Effect of treatment of obstructive sleep apnea on depressive symptoms: systematic review and meta-analysis. PLoS Med. 2014;11(11):e1001762. PubMed CrossRef
  46. Harris LM, Huang X, Linthicum KP, et al. Sleep disturbances as risk factors for suicidal thoughts and behaviours: a meta-analysis of longitudinal studies. Sci Rep. 2020;10(1):13888. PubMed CrossRef
  47. Bishop TM, Ashrafioun L, Pigeon WR. The association between sleep apnea and suicidal thought and behavior: an analysis of national survey data. J Clin Psychiatry. 2018;79(1):17m11480. PubMed CrossRef
  48. Gupta MA, Jarosz P. Obstructive sleep apnea severity is directly related to suicidal ideation in posttraumatic stress disorder. J Clin Sleep Med. 2018;14(3):427–435. PubMed CrossRef
  49. Reddy A, Mansuri Z, Trivedi C, et al. Does obstructive sleep apnea increase suicidality in patients with bipolar disorder? (abstract 760) Sleep. 2021;44(suppl 2):A296. CrossRef
  50. Zhang J, Weaver TE, Zhong Z, et al. White matter structural differences in OSA patients experiencing residual daytime sleepiness with high CPAP use: a non-Gaussian diffusion MRI study. Sleep Med. 2019;53:51–59. PubMed CrossRef
  51. Xiong Y, Zhou XJ, Nisi RA, et al. Brain white matter changes in CPAP-treated obstructive sleep apnea patients with residual sleepiness. J Magn Reson Imaging. 2017;45(5):1371–1378. PubMed CrossRef
  52. Lal C, Weaver TE, Bae CJ, et al. Excessive daytime sleepiness in obstructive sleep apnea: mechanisms and clinical management. Ann Am Thorac Soc. 2021;18(5):757–768. PubMed CrossRef
  53. Cross RL, Kumar R, Macey PM, et al. Neural alterations and depressive symptoms in obstructive sleep apnea patients. Sleep. 2008;31(8):1103–1109. PubMed
  54. Kumar R, Macey PM, Cross RL, et al. Neural alterations associated with anxiety symptoms in obstructive sleep apnea syndrome. Depress Anxiety. 2009;26(5):480–491. PubMed CrossRef
  55. Liguori C, Mercuri NB, Izzi F, et al. Obstructive sleep apnea is associated with early but possibly modifiable Alzheimer’s disease biomarkers changes. Sleep. 2017;40(5):zsx011. PubMed CrossRef
  56. Cai L, Huang J. Schizophrenia and risk of dementia: a meta-analysis study. Neuropsychiatr Dis Treat. 2018;14:2047–2055. PubMed CrossRef
  57. Cantón-Habas V, Rich-Ruiz M, Romero-Saldaña M, et al. Depression as a risk factor for dementia and Alzheimer’s disease. Biomedicines. 2020;8(11):457. PubMed CrossRef
  58. Zilkens RR, Bruce DG, Duke J, et al. Severe psychiatric disorders in mid-life and risk of dementia in late-life (age 65-84 years): a population based case-control study. Curr Alzheimer Res. 2014;11(7):681–693. PubMed CrossRef
  59. Minhas S, Patel JR, Malik M, et al. Mind-body connection: cardiovascular sequelae of psychiatric illness. Curr Probl Cardiol. 2022;47(10):100959. PubMed CrossRef
  60. Lévy P, Kohler M, McNicholas WT, et al. Obstructive sleep apnoea syndrome. Nat Rev Dis Primers. 2015;1(1):15015. PubMed CrossRef
  61. McNicholas WT, Bonsignore MR, Lévy P, et al. Mild obstructive sleep apnoea: clinical relevance and approaches to management. Lancet Respir Med. 2016;4(10):826–834. PubMed CrossRef
  62. Mazzotti DR, Keenan BT, Lim DC, et al. Symptom subtypes of obstructive sleep apnea predict incidence of cardiovascular outcomes. Am J Respir Crit Care Med. 2019;200(4):493–506. PubMed CrossRef
  63. Drager LF, McEvoy RD, Barbe F, et al; INCOSACT Initiative (International Collaboration of Sleep Apnea Cardiovascular Trialists). Sleep apnea and cardiovascular disease: lessons from recent trials and need for team science. Circulation. 2017;136(19):1840–1850. PubMed CrossRef
  64. Hirsch Allen AJM, Bansback N, Ayas NT. The effect of OSA on work disability and work-related injuries. Chest. 2015;147(5):1422–1428. PubMed CrossRef
  65. Nena E, Steiropoulos P, Constantinidis TC, et al. Work productivity in obstructive sleep apnea patients. J Occup Environ Med. 2010;52(6):622–625. PubMed CrossRef
  66. Jermann F, Perroud N, Favre S, et al. Quality of life and subjective sleep-related measures in bipolar disorder and major depressive disorder. Qual Life Res. 2022;31(1):117–124. PubMed
  67. Ward KL, Hillman DR, James A, et al. Excessive daytime sleepiness increases the risk of motor vehicle crash in obstructive sleep apnea. J Clin Sleep Med. 2013;9(10):1013–1021. PubMed CrossRef
  68. Hill LL, Lauzon VL, Winbrock EL, et al. Depression, antidepressants and driving safety. Inj Epidemiol. 2017;4(1):10. PubMed CrossRef
  69. Uvais NA. Mental health conditions and the risk of road traffic accidents. J Family Med Prim Care. 2019;8(6):2166–2167. PubMed CrossRef
  70. Zhao YY, Wang R, Gleason KJ, et al; BestAIR Investigators. Effect of continuous positive airway pressure treatment on health-related quality of life and sleepiness in high cardiovascular risk individuals with sleep apnea: Best Apnea Interventions for Research (BestAIR) Trial. Sleep. 2017;40(4):zsx040. PubMed CrossRef
  71. Hirshkowitz M, Black J. Effect of adjunctive modafinil on wakefulness and quality of life in patients with excessive sleepiness-associated obstructive sleep apnoea/hypopnoea syndrome: a 12-month, open-label extension study. CNS Drugs. 2007;21(5):407–416. PubMed CrossRef
  72. Weaver TE, Drake CL, Benes H, et al. Effects of solriamfetol on quality of life measures from a 12-week phase 3 randomized trial. Ann Am Thorac Soc. 2020;17(8):998–1007. PubMed CrossRef
  73. Lin YC, Chen TY, Chien WC, et al. Stimulants associated with reduced risk of hospitalization for motor vehicle accident injury in patients with obstructive sleep apnea: a nationwide cohort study. BMC Pulm Med. 2020;20(1):28. PubMed CrossRef
  74. Chervin RD. Sleepiness, fatigue, tiredness, and lack of energy in obstructive sleep apnea. Chest. 2000;118(2):372–379. PubMed CrossRef
  75. Smith S, Rossdale J, Serry Y, et al. Multiple dimensions of excessive daytime sleepiness. J Thorac Dis. 2018;10(suppl 1):S170–S176. PubMed CrossRef
  76. Marti-Soler H, Hirotsu C, Marques-Vidal P, et al. The NoSAS score for screening of sleep-disordered breathing: a derivation and validation study. Lancet Respir Med. 2016;4(9):742–748. PubMed CrossRef
  77. Chung F, Abdullah HR, Liao P. STOP-Bang questionnaire: a practical approach to screen for obstructive sleep apnea. Chest. 2016;149(3):631–638. PubMed CrossRef
  78. Netzer NC, Stoohs RA, Netzer CM, et al. Using the Berlin Questionnaire to identify patients at risk for the sleep apnea syndrome. Ann Intern Med. 1999;131(7):485–491. PubMed CrossRef
  79. Guichard K, Marti-Soler H, Micoulaud-Franchi JA, et al. The NoSAS score: a new and simple screening tool for obstructive sleep apnea syndrome in depressive disorder. J Affect Disord. 2018;227:136–140. PubMed CrossRef
  80. Rosenberg R, Schweitzer PK, Steier J, et al. Residual excessive daytime sleepiness in patients treated for obstructive sleep apnea: guidance for assessment, diagnosis, and management. Postgrad Med. 2021;133(7):772–783. PubMed CrossRef
  81. Sowa NA. Idiopathic hypersomnia and hypersomnolence disorder: a systematic review of the literature. Psychosomatics. 2016;57(2):152–164. PubMed CrossRef
  82. Barateau L, Lopez R, Franchi JA, et al. Hypersomnolence, hypersomnia, and mood disorders. Curr Psychiatry Rep. 2017;19(2):13. PubMed CrossRef
  83. Xanax [package insert]. Pfizer Inc; 2011.
  84. Valium [package insert]. Genentech; 2021.
  85. Roth T, Dauvilliers Y, Mignot E, et al. Disrupted nighttime sleep in narcolepsy. J Clin Sleep Med. 2013;9(9):955–965. PubMed CrossRef
  86. Ambien [package insert]. Sanofi-Aventis US; 2008.
  87. Rishi MA, Shetty M, Wolff A, et al. Atypical antipsychotic medications are independently associated with severe obstructive sleep apnea. Clin Neuropharmacol. 2010;33(3):109–113. PubMed CrossRef
  88. Ancoli-Israel S, Vanover KE, Weiner DM, et al. Pimavanserin tartrate, a 5-HT(2A) receptor inverse agonist, increases slow wave sleep as measured by polysomnography in healthy adult volunteers. Sleep Med. 2011;12(2):134–141. PubMed CrossRef
  89. Haldol [package insert]. Ortho-McNeil Pharmaceutical; 2009.
  90. Smith SS, Dingwall K, Jorgenson G, et al. Associations between the use of common medications and sleep architecture in patients with untreated obstructive sleep apnea. J Clin Sleep Med. 2006;2(2):156–162. PubMed CrossRef
  91. Kraiczi H, Hedner J, Dahlöf P, et al. Effect of serotonin uptake inhibition on breathing during sleep and daytime symptoms in obstructive sleep apnea. Sleep. 1999;22(1):61–67. PubMed
  92. Paxil [package insert]. GlaxoSmithKline; 2012.
  93. Prozac [package insert]. Eli Lilly and Company; 2017.
  94. Celexa [package insert]. Forest Pharmaceuticals; 2009.
  95. Viibryd [package insert]. Trovis Pharmaceuticals; 2010.
  96. Luvox [package insert]. Jazz Pharmaceuticals; 2008.
  97. Effexor [package insert]. Wyeth Pharmaceuticals; 2008.
  98. Cymbalta [package insert]. Eli Lilly and Company; 2010.
  99. Wichniak A, Wierzbicka A, Walęcka M, et al. Effects of antidepressants on sleep. Curr Psychiatry Rep. 2017;19(9):63. PubMed CrossRef
  100. Desyrel [package insert]. Pragma Pharmaceuticals; 2017.
  101. Wellbutrin [package insert]. GlaxoSmithKline; 2017.
  102. Remeron [package insert]. Organon USA; 2007.
  103. Zelapar [package insert]. Valeant Pharmaceuticals North America; 2008.
  104. Amitriptyline HCl [package insert]. Sandoz Inc; 2014.
  105. Protriptyline Hydrochloride [package insert]. West-Ward Pharmaceuticals; 2016.
  106. Imipramine Hydrochloride [package insert]. Excellium Pharmaceuticals; 2012.
  107. Norpramin [package insert]. Sanofi-Aventis US; 2014.
  108. Anafranil [package insert]. Mallinckrodt Inc; 2012.
  109. Depakene [package insert]. Abbott Laboratories; 2011.
  110. Tegretol [package insert]. Novartis Pharmaceuticals Corporation; 2009.
  111. Lamictal [package insert]. GlaxoSmithKline; 2009.
  112. Sahni AS, Carlucci M, Malik M, et al. Management of excessive sleepiness in patients with narcolepsy and OSA: current challenges and future prospects. Nat Sci Sleep. 2019;11:241–252. PubMed CrossRef
  113. Klonopin [package insert]. Genentech; 2013.
  114. Lunesta [package insert]. Sunovion Pharmaceuticals; 2014.
  115. Largactil [package insert]. Sanofi-Aventis New Zealand Limited; 2013.
  116. Ativan C-IV [package insert]. Valeant Pharmaceuticals North America; 2016.
  117. Zoloft [package insert]. Pfizer Inc.; 2016.
  118. Lexapro [package insert]. Allergan, Inc; 2017.
  119. Abilify [package insert]. Otsuka Pharmaceuticals; 2014.
  120. Clozaril [package insert]. Novartis Pharmaceuticals; 2020.
  121. Zyprexa [package insert]. Eli Lilly and Company; 2021.
  122. Invega [package insert]. Janssen Pharmaceuticals; 2021.
  123. Seroquel [package insert]. AstraZeneca Pharmaceuticals; 2016.
  124. Risperdal [package insert]. Ortho-McNeil-Janssen Pharmaceuticals; 2009.
  125. Shirani A, Paradiso S, Dyken ME. The impact of atypical antipsychotic use on obstructive sleep apnea: a pilot study and literature review. Sleep Med. 2011;12(6):591–597. PubMed CrossRef
  126. Hanzel DA, Proia NG, Hudgel DW. Response of obstructive sleep apnea to fluoxetine and protriptyline. Chest. 1991;100(2):416–421. PubMed CrossRef
  127. Patil SP, Ayappa IA, Caples SM, et al. Treatment of adult obstructive sleep apnea with positive airway pressure: an American Academy of Sleep Medicine systematic review, meta-analysis, and GRADE assessment. J Clin Sleep Med. 2019;15(2):301–334. PubMed CrossRef
  128. Rotty MC, Suehs CM, Mallet JP, et al. Mask side-effects in long-term CPAP-patients impact adherence and sleepiness: the InterfaceVent real-life study. Respir Res. 2021;22(1):17. PubMed CrossRef
  129. Weaver TE, Sawyer AM. Adherence to continuous positive airway pressure treatment for obstructive sleep apnoea: implications for future interventions. Indian J Med Res. 2010;131:245–258. PubMed
  130. Budhiraja R, Kushida CA, Nichols DA, et al. Impact of randomization, clinic visits, and medical and psychiatric comorbidities on continuous positive airway pressure adherence in obstructive sleep apnea. J Clin Sleep Med. 2016;12(3):333–341. PubMed CrossRef
  131. Veasey SC, Rosen IM. Obstructive sleep apnea in adults. N Engl J Med. 2019;380(15):1442–1449. PubMed CrossRef
  132. Epstein LJ, Kristo D, Strollo PJ Jr, et al; Adult Obstructive Sleep Apnea Task Force of the American Academy of Sleep Medicine. Clinical guideline for the evaluation, management and long-term care of obstructive sleep apnea in adults. J Clin Sleep Med. 2009;5(3):263–276. PubMed CrossRef
  133. Gasa M, Tamisier R, Launois SH, et al; Scientific Council of the Sleep Registry of the French Federation of Pneumology-FFP. Residual sleepiness in sleep apnea patients treated by continuous positive airway pressure. J Sleep Res. 2013;22(4):389–397. PubMed CrossRef
  134. Pépin JL, Viot-Blanc V, Escourrou P, et al. Prevalence of residual excessive sleepiness in CPAP-treated sleep apnoea patients: the French multicentre study. Eur Respir J. 2009;33(5):1062–1067. PubMed CrossRef
  135. Chapman JL, Serinel Y, Marshall NS, et al. Residual daytime sleepiness in obstructive sleep apnea after continuous positive airway pressure optimization: causes and management. Sleep Med Clin. 2016;11(3):353–363. PubMed CrossRef
  136. Sunosi [package insert]. Jazz Pharmaceuticals, Inc; 2021.
  137. Provigil [package insert]. Teva Pharmaceuticals; 2018.
  138. Nuvigil [package insert]. Teva Pharmaceuticals; 2018.
  139. Strollo PJ Jr, Hedner J, Collop N, et al; Tones 4 Study Investigators. Solriamfetol for the treatment of excessive sleepiness in OSA: a placebo-controlled randomized withdrawal study. Chest. 2019;155(2):364–374. PubMed CrossRef
  140. Schweitzer PK, Rosenberg R, Zammit GK, et al; TONES 3 Study Investigators. Solriamfetol for excessive sleepiness in obstructive sleep apnea (TONES 3): a randomized controlled trial. Am J Respir Crit Care Med. 2019;199(11):1421–1431. PubMed CrossRef
  141. Malhotra A, Shapiro C, Pepin JL, et al. Long-term study of the safety and maintenance of efficacy of solriamfetol (JZP-110) in the treatment of excessive sleepiness in participants with narcolepsy or obstructive sleep apnea. Sleep. 2020;43(2):zsz220. PubMed CrossRef
  142. Krystal AD, Benca RM, Rosenberg R, et al. Solriamfetol treatment of excessive daytime sleepiness in participants with narcolepsy or obstructive sleep apnea with a history of depression. J Psychiatr Res. 2022;155:202–210. PubMed CrossRef
  143. Kuan YC, Wu D, Huang KW, et al. Effects of modafinil and armodafinil in patients with obstructive sleep apnea: a meta-analysis of randomized controlled trials. Clin Ther. 2016;38(4):874–888. PubMed CrossRef
  144. Fava M, Thase ME, DeBattista C. A multicenter, placebo-controlled study of modafinil augmentation in partial responders to selective serotonin reuptake inhibitors with persistent fatigue and sleepiness. J Clin Psychiatry. 2005;66(1):85–93. PubMed CrossRef
  145. DeBattista C, Doghramji K, Menza MA, et al; Modafinil in Depression Study Group. Adjunct modafinil for the short-term treatment of fatigue and sleepiness in patients with major depressive disorder: a preliminary double-blind, placebo-controlled study. J Clin Psychiatry. 2003;64(9):1057–1064. PubMed CrossRef
  146. Fava M, Thase ME, DeBattista C, et al. Modafinil augmentation of selective serotonin reuptake inhibitor therapy in MDD partial responders with persistent fatigue and sleepiness. Ann Clin Psychiatry. 2007;19(3):153–159. PubMed CrossRef
  147. Goss AJ, Kaser M, Costafreda SG, et al. Modafinil augmentation therapy in unipolar and bipolar depression: a systematic review and meta-analysis of randomized controlled trials. J Clin Psychiatry. 2013;74(11):1101–1107. PubMed CrossRef
  148. Nunez NA, Singh B, Romo-Nava F, et al. Efficacy and tolerability of adjunctive modafinil/armodafinil in bipolar depression: a meta-analysis of randomized controlled trials. Bipolar Disord. 2020;22(2):109–120. PubMed CrossRef
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