Effects of nasal continuous positive airway pressure on panic disorder comorbid with obstructive sleep apnea syndrome☆

Abstract 

Backgrounds

Both obstructive sleep apnea syndrome (OSAS) and panic disorder (PD) are common disorders that often coexist. Continuous positive airway pressure (CPAP) has been established as the first-line treatment for OSAS. In this study, we examined the efficacy of CPAP on PD comorbid with OSAS by conducting a randomized crossover study using sham CPAP as control.

Methods

PD patients (n=12) with an apnea hypopnea index (AHI) of 20/h or higher completed the study. At baseline, the subjects were asked to write their own records pertaining to the frequency of attacks and their score on the panic disorder severity scale (PDSS), and then they participated in the randomized crossover trial period, which measured optimal CPAP and sham CPAP set at 4cmH₂O during nighttime sleep for each 4-week assignment.

Results

The frequency of panic attacks, total PDSS score, and the frequency of alprazolam use for alleviating the attack symptoms were significantly decreased during the optimal CPAP period than during the baseline period and the sham CPAP period. Among the PDSS subitems, the frequency of attacks, panic distress, work impairment, and social impairment showed significant improvements during the optimal pressure period.

Conclusion

Our results suggest that OSAS contributes to PD aggravation, and a combination of pharmaceutical treatment for PD and OSAS-specific treatments such as CPAP could be recommended for patients with PD comorbid with OSAS.

Abbreviations: OSAS, Obstructive sleep apnea syndrome, PD, panic disorder, CPAP, continuous positive airway pressure, PSG, polysomnography, AHI, apnea hypopnea index, EEG, electroencephalogram, BMI, body mass index, PDSS, panic disorder severity scale, CBT, cognitive-behavioral therapy

Keywords: Sleep apnea syndrome, Panic disorder, Continuous positive airway pressure, Panic attack, Panic disorder severity scale, Apnea hypopnea index