Sleep and Medical/Psychiatric Comorbidity
Bidirectional relationships
Sleep and medical illness interact in both directions. OSA worsens hypertension, atrial fibrillation, heart failure, and stroke risk; treatment may improve control. Chronic insomnia and short sleep associate with depression and anxiety, and depression itself causes insomnia and hypersomnia. Screen for mood disorders when insomnia is chronic.
Specific associations
- COPD: nocturnal hypoxemia and poor sleep quality; overlap syndrome with OSA worsens outcomes.
- Asthma: nocturnal symptoms reflect circadian airway changes.
- GERD: worsens with supine position and OSA.
- Chronic pain and fibromyalgia: fragmented sleep amplifies pain.
- Neurodegenerative disease: RBD and sleep fragmentation.
- Pregnancy: OSA risk rises; snoring warrants evaluation.
Traps
- Insomnia may be a symptom of depression; treating only sleep misses the diagnosis.
- Benzodiazepines can worsen OSA and falls in older adults.
- Opioids can cause central apnea and hypoventilation.
- Do not attribute all sleepiness to psychiatric illness; rule out OSA and narcolepsy.
Rule of thumb
When a patient has resistant hypertension, AF, or stroke, ask about snoring and consider OSA evaluation.