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A false alarm of narcolepsy: obstructive sleep apnea masquerading as narcolepsy and depression

  • Dhirendra Paudel
  • Qiuyan Lin
  • Caiping Yan
  • Shuai Liu
  • Bin Zhang
Sleep Breathing Physiology and Disorders • Short Communication
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Abstract

Purpose

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.

Methods

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.

Results

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.

Conclusions

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.

Keywords

Obstructive sleep apnea Narcolepsy Depression 

Abbreviations

AHI

apnea/hypopnea index

CPAP

continuous positive airway pressure

ESS

Epworth Sleepiness Scale

HAMA

Hamilton Anxiety Rating Scale

HAMD

Hamilton Depression Rating Scale

MINI

MINI-International Neuropsychiatric Interview

MSLT

Multiple Sleep Latency Test

OSA

obstructive sleep apnea

PLMI

periodic limb movement index

PSG

polysomnography

PSQI

Pittsburgh Sleep Quality Index

SOREMP

sleep-onset rapid eye movement period

Notes

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

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.

Informed consent

Additional informed consent was obtained from the patient for any identifying information is included in this article.

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Copyright information

© Springer Nature Switzerland AG 2018

Authors and Affiliations

  • Dhirendra Paudel
    • 1
  • Qiuyan Lin
    • 1
  • Caiping Yan
    • 1
  • Shuai Liu
    • 1
  • Bin Zhang
    • 1
  1. 1.Department of Psychiatry, Nanfang HospitalSouthern Medical UniversityGuangzhouChina

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