An abstract of this study was presented at the American Psychiatric Association 165th Annual Meeting, May 5–9, 2012, Philadelphia, PA, USA.
CPAP-induced mania in bipolar disorder: a case report
Article first published online: 27 AUG 2013
© 2013 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.
Volume 15, Issue 7, pages 803–807, November 2013
How to Cite
CPAP-induced mania in bipolar disorder: a case report. Bipolar Disord 2013: 15: 803–807. © 2013 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd., , , .
- Issue published online: 5 NOV 2013
- Article first published online: 27 AUG 2013
- Manuscript Accepted: 6 MAR 2013
- Manuscript Received: 27 AUG 2012
- bipolar disorder;
- continuous positive airway pressure;
- obstructive sleep apnea;
In this case report we present our clinical observations of two patients with bipolar disorder with comorbid obstructive sleep apnea (OSA) who were treated with continuous positive airway pressure (CPAP) for their sleep apnea.
Bipolar disorder is a psychiatric disorder characterized by the presence of one or more episodes of mania and frequent episodes of depression. This disorder affects approximately 0.8% of the adult population, with estimates from community samples ranging between 0.4% and 1.6%. OSA syndrome is a severe sleep disorder with a prevalence of 2–4% in the general population, the risk of which is increased by obesity. The prevalence of OSA is expected to be high in bipolar disorder due to high comorbid obesity. It is expected that improvement in OSA in patients with bipolar disorder with CPAP will improve mood and other symptoms of bipolar disorder. However, there is a relative lack of data examining this aspect.
In both cases of bipolar disorder, CPAP was started after a polysomnographic diagnosis of OSA and CPAP titration study indicating that most of the apneas/hypopneas were eliminated with a significant improvement in oxygen saturation. To our surprise, we noted that in both of these cases initiation of CPAP resulted in manic symptoms.
Clinicians need to monitor patients with bipolar disorder closely for worsening of manic symptoms when they are started on CPAP for underlying OSA.