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OSA in Psychiatric Patients: Insomnia as a Concurrent Presentation of Autonomic Dysregulation in OSA.

Journal of Clinical Sleep Medicine, Vol. 11, No. 5, 2015 strong evidence that OSA can be present in even the lowest risk MDD patients.2 The fi ndings of McCall et al. also suggest that insomnia and OSA are not necessarily independent conditions, especially in patients with autonomic dysregulation at the primary central nervous level, such as in some psychiatric patients. Different levels of autonomic nervous system activation and resultant hyperarousal and sleep fragmentation could result in varying levels of insomnia in OSA patients with psychiatric disorders. It is therefore possible that levels of insomnia in the psychiatric patient with OSA vary over time, depending upon the severity of the psychiatric disorder and level of autonomic activation. This underscores the importance of considering sleep fragmentation as a principal component of the neurological, metabolic, and biologic factors contributing to severity and treatment resistance in psychiatric disorders. We hope that this information will spur the increased use of PSG as a part of the psychiatric diagnostic toolkit.