A false alarm of narcolepsy: obstructive sleep apnea masquerading as narcolepsy and depression
- 94 Downloads
We report a case with symptoms and signs of obstructive sleep apnea (OSA), depression, and narcolepsy. Polysomnographic (PSG) and multiple sleep latency test (MSLT) findings, clinical characteristics, and diagnostic challenges in this case are discussed.
A 23-year-old single male presented with excessive daytime sleepiness, low mood, lack of energy, and snoring for 3 years. In addition, he reported excessive weight gain, lack of interest in work, partial loss of muscle tone during excitations, and sleep attacks during work and driving. He had experienced three episodes of sleep paralysis. The patient underwent a sleep study including PSG and MSLT.
On baseline PSG, he had an apnea/hypopnea index (AHI) of 72.8/h. The MSLT showed a mean sleep latency of 3.8 min and two sleep-onset rapid eye movement periods (SOREMPs). On admission, he had an Epworth Sleepiness Scale (ESS) score of 21, and positive findings for depression in the clinical interview and psychometric scales. He was treated with continuous positive airway pressure without any medication. Follow-up PSG and MSLT were performed after 1 week, which showed an AHI of 0/h without SOREMPs. After 1 month, there was no sign of depression.
This study reflects that OSA can present with cataplexy-like features and false positive MSLT results for narcolepsy, as well as depressive symptoms. The case highlights the complexity in which OSA can present to physicians, and emphasizes that clinicians should be aware that OSA can mimic narcolepsy and present with depressive symptoms.
KeywordsObstructive sleep apnea Narcolepsy Depression
continuous positive airway pressure
Epworth Sleepiness Scale
Hamilton Anxiety Rating Scale
Hamilton Depression Rating Scale
MINI-International Neuropsychiatric Interview
Multiple Sleep Latency Test
obstructive sleep apnea
periodic limb movement index
Pittsburgh Sleep Quality Index
sleep-onset rapid eye movement period
Compliance with ethical standards
Conflict of interest
The authors declare that they have no conflict of interest.
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
Additional informed consent was obtained from the patient for any identifying information is included in this article.
- 8.Chen W, Mignot E (2007) CHAPTER 6 - narcolepsy and hypersomnia of central origin: diagnosis, differential pearls, and management. In: Barkoukis TJ, Avidan AY (eds) Review of sleep medicine (Second Edition). Butterworth-Heinemann, Philadelphia, pp 75–94. https://doi.org/10.1016/B978-075067563-5.10006-9
- 9.Kim CY, Ong A, Chung SA, Shapiro CM (2012) SOREMs in sleep clinic patients: association with sleepiness, alertness and fatigue. Sleep Hypn 14(1):20–28Google Scholar
- 11.Drakatos P, Suri A, Higgins SE, Ebrahim IO, Muza RT, Kosky CA, Williams AJ, Leschziner GD (2013) Sleep stage sequence analysis of sleep onset REM periods in the hypersomnias. J Neurol Neurosurg Psychiatry 84(2):223–227. https://doi.org/10.1136/jnnp-2012-303578 CrossRefPubMedPubMedCentralGoogle Scholar