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

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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.

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Fig. 1

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

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Author notes

  1. Dhirendra Paudel, Qiuyan Lin and Caiping Yan contributed equally to this work.

Authors and Affiliations

  1. Department of Psychiatry, Nanfang Hospital, Southern Medical University, Guangzhou, China

    Dhirendra Paudel, Qiuyan Lin, Caiping Yan, Shuai Liu & Bin Zhang

Authors
  1. Dhirendra Paudel
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  2. Qiuyan Lin
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  3. Caiping Yan
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  4. Shuai Liu
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  5. Bin Zhang
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Corresponding author

Correspondence to Bin Zhang.

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The authors declare that they have no conflict of interest.

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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.

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Paudel, D., Lin, Q., Yan, C. et al. A false alarm of narcolepsy: obstructive sleep apnea masquerading as narcolepsy and depression. Sleep Breath 23, 873–877 (2019). https://doi.org/10.1007/s11325-018-1767-7

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  • DOI: https://doi.org/10.1007/s11325-018-1767-7

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