Mini Review

Sleep Apnea – A Psychological, Neurological and Suicidal Agent

Mohammad Azizur Rahman*

Department of Biochemistry and Molecular Biology, Jahangirnagar University, Bangladesh

Submission: July 11, 2024; Published: July 23, 2024

*Corresponding author: Mohammad Azizur Rahman, Department of Biochemistry and Molecular Biology, Jahangirnagar University, Bangladesh

How to cite this article: Mohammad Azizur R. Sleep Apnea – A Psychological, Neurological and Suicidal Agent. Psychol Behav Sci Int J. 2024; 22(1): 556077. DOI: 10.19080/PBSIJ.2024.22.556077.

Abstract

Sleep apnea has been causing grave physiological, psychological, behavioral and neurological consequences. Though immense number of people have been suffering from sleep apnea, its pathological hallmarks and amendment strategies have remained overlooked. Co-morbidities of sleep apnea has not received considerable attention. Thus, this article has been aimed at elucidating the psychological, neurological and suicidal co-morbidities of sleep apnea. Health care professionals, policy-makers, public health researchers and scientists of diverse field would be highly benefitted from the viewpoints described in this article.

Keywords: Central sleep apnea; Obstructive sleep apnea; Neurodegeneration; Alzheimer’s disease; Parkinson’s disease; Suicide

Abbreviations: OSA: Obstructive Sleep Apnea, CSA: Central Sleep Apnea; ND: Neurodegenerative Diseases; ROS: Reactive Oxygen Species; AD: Alzheimer’s Disease; PD: Parkinson’s DiseaseTherapy

Psychological, Behavioral, Neurological and Suicidal Co-Morbidities of Sleep Apnea

Sleep apnea is a physiological disorder that occurs during sleep and causes respiratory pauses [1]. The person undergoing sleep apnea suffers from collapsing of the upper respiratory airway that results in poor or blocked breathing, cessation in breathing and disturbed sleeping [1]. Choking and snoring accompany breathing and sleeping disturbance [1]. As proper sleeping and oxygenation becomes hampered, the sleep apnea patient suffer from feelings of excessive sleeping during daytime, weakness and other physical and psychological problems [1]. Globally, more than 936 million people suffer from sleep apnea and most of them have been found with obstructive sleep apnea (OSA) [2]. Besides, another type of sleep apnea, called central sleep apnea (CSA) occurs due to neurological failure on breathing control [3-10]. Most common psychological hallmarks of sleep apnea are anxiety, depression, irritation, lethargy, laziness, schizophrenia, aloofness and stress [3-10]. Though different physiological and psychological problems have been associated with sleep apnea, its link with neurodegenerative diseases (ND), cognition, learning and memory have been less discussed [3-12]. This article intricately links the relationship between these physiological abnormalities along with suicide. Cognitive performance include attention, language, learning, memory, thinking, planning, problem solving and other executive functioning abilities [3-12]. OSA impairs almost all the cognitive aspects of the sufferers. OSA induced hypoxia (blood level of reduced oxygen) and hypercapnia (blood level of increased carbon dioxide) alter normal metabolic and physiological processes [3-12].

Also, enhanced level of reactive oxygen species (ROS) impairs cellular functioning. OSA stimulates excessive generation and accumulation of amyloid beta (Aβ) plaque and thus is directly linked with Alzheimer’s disease (AD) [10-12]. Neuroimaging studies of the OSA patients revealed abnormal grey matter structure linked with those of the AD patients [10-12]. Sleep apnea also stimulates Parkinson’s disease (PD) generation [13-17]. Painstakingly, sleep apnea also sets the ground of suicide [18-23]. Suicidal ideations have been linked with sleep apnea in multiple studies [18-23]. Thus, management of sleep apnea is essential to reduce neurodegenerative diseases, cognitive impairments and suicidal tendencies or suicide.

Conclusion

Sleep apnea has been plaguing the humanity in the guise of a silent killer. Its management strategies should be disseminated to the community so that the sufferers find easy way to sustain and lead their normal life. Awareness programs against the grave consequences of sleep apnea including psychological, behavioral, neurological and suicide should be raised globally. Policy-makers at national and international levels should formulate strategies to combat sleep apnea.

References

1. Dempsey JA, Veasey SC, Morgan BJ, O'Donnell CP (2010) Pathophysiology of sleep apnea. Physiological reviews 90(1): 47-112.
2. Sharafkhaneh A, Giray N, Richardson P, Young T, Hirshkowitz M (2005) Association of psychiatric disorders and sleep apnea in a large cohort. Sleep 28(11): 1405-1411.
3. Krysta K, Bratek A, Zawada K, Stepańczak R (2017) Cognitive deficits in adults with obstructive sleep apnea compared to children and adolescents. Journal of Neural Transmission 124(Suppl 1): 187-201.
4. Marchi NA, Solelhac G, Berger M, Haba-Rubio J, Gosselin N, et al. 2023 Obstructive sleep apnoea and 5-year cognitive decline in the elderly. Eur Respir J 61(4): 2201621.
5. Weihs A, Frenzel S, Grabe HJ (2021) The link between obstructive sleep apnoea and neurodegeneration and cognition. Current Sleep Medicine Reports 7: 87-96.
6. Lal C, Ayappa I, Ayas N, Beaudin AE, Hoyos C, Kushida CA, et al. (2022) The link between obstructive sleep apnea and neurocognitive impairment: an official American thoracic society workshop report. Annals of the American Thoracic Society 19(8): 1245-1256.
7. Ibrahim A, Högl B, Stefani A (2024) The Bidirectional Relationship between Sleep and Neurodegeneration: Actionability to Improve Brain Health. Clinical and Translational Neuroscience 8(1): 11.
8. Alhifzi S, Zaki N, BaHammam AS 2022 Behavioral Presentations of Sleep-Related Breathing Disorders. In Sleep and Neuropsychiatric Disorders Singapore Springer Nature Singapore: pp235-253.
9. Anghel L, Ciubară A, Nechita A, Nechita L, Manole C et al. (2023) Sleep disorders associated with neurodegenerative diseases. Diagnostics 13(18): 2898.
10. Andrade AG, Bubu OM, Varga AW, Osorio RS ‘92018) The relationship between obstructive sleep apnea and Alzheimer’s disease. Journal of Alzheimer's Disease 64(s1): S255-S270.
11. Kong W, Zang Y (2023) Alzheimer’s disease biomarkers in patients with obstructive sleep apnea hypopnea syndrome and effects of surgery: A prospective cohort study. Frontiers in Aging Neuroscience 14: 959472.
12. Zeng J, Wei M, Li T, Chen W, Feng Y, et al. (2013) Risk of obstructive sleep apnea in Parkinson’s disease: a meta-analysis. PLoS One 8(12): e82091.
13. Sheu JJ, Lee HC, Lin HC, Kao LT, Chung SD (2015’0 A 5-year follow-up study on the relationship between obstructive sleep apnea and Parkinson disease. Journal of Clinical Sleep Medicine 11(12): 1403-1408.
14. Crosta F, Desideri G Marini C (2017) Obstructive sleep apnea syndrome in Parkinson’s disease and other parkinsonisms. Functional neurology 32(3): 137-141.
15. Shafqat, Muhammad Nabeel, Muhammad Aadil, Maria Shoaib (2017) Sleep apnea leading to Parkinson’s disease–an important association. Neuropsychiatric Disease and Treatment 13: 1491-1492.
16. Sobreira-Neto MA, Pena-Pereira MA, Sobreira EST, Chagas MHN, Almeida CMOD, et al. (2019) Obstructive sleep apnea and Parkinson's disease: characteristics and associated factors. Arquivos de Neuro-psiquiatria 77(9): 609-616.
17. Pigeon WR, Titus CE, Bishop TM (2016) The relationship of suicidal thoughts and behaviors to sleep disturbance: A review of recent findings. Current Sleep Medicine Reports 2: 241-250.
18. Harris LM, Huang X, Linthicum KP, Bryen CP, Ribeiro JD (2020) Sleep disturbances as risk factors for suicidal thoughts and behaviours: a meta-analysis of longitudinal studies. Scientific Reports 10(1): 13888.
19. Siddiqui M, Al-Amin H, Rabeh MA, Meedany M, Hamdi Y, et al. (2022) Self-reported sleep and exercise patterns in patients admitted with suicidal attempts: a cross-sectional comparative study. BMC psychiatry 22(1): 326.
20. Bishop TM, Youngren WA, Klein JS, Speed KJ, Pigeon WR (2023) Sleep disorders and suicide attempts following discharge from residential treatment. Frontiers in Sleep 2: 1173650.
21. Lee MR, Jung SM (2023) Obstructive sleep apnea related to mental health, health-related quality of life and multimorbidity: A nationwide survey of a representative sample in Republic of Korea. Plos one 18(6): e0287182.
22. Gupta MA, Jarosz P (2018) Obstructive sleep apnea severity is directly related to suicidal ideation in posttraumatic stress disorder. Journal of clinical sleep medicine 14(3): 427-435.
23. Krahn LE, Miller BW, Bergstrom LR (2008) Rapid resolution of intense suicidal ideation after treatment of severe obstructive sleep apnea. Journal of clinical sleep medicine 4(1): 64-65.