Comments(1)

Schroder and O'Hara's Depression and Obstructive Sleep Apnea: An Informed Lay Perspective

Mary Bryan (19 August 2007) Retired Educational Administrator

Having received a diagnosis of mild to moderate Obstructive Sleep Apnea (OSA) only days ago (7/16/2007), I began an intensive search for journal articles and papers with three goals in mind:

1) to expand and deepen my own understanding of the condition;

2) to explore the relationship - if any - between

a) reduced oxygen saturation demonstrated via comprehensive sleep studies, and

b) clinical white matter changes observed on MRI (e.g., multiple lacunar infarcts, scattered tiny hemosiderin deposits, and other signs indicating subcortical stroke-related small vessel disease); and

3) to apply this information in the development of a research-based article or series of articles using language that is at once scientifically and medically accurate, and accessible to the informed lay reader, whether personally affected or concerned for a family member, loved one, or acquaintance. Schroder and O'Hara's review of the literature on Depression and Sleep Apnea both raised and answered questions that I had not yet begun to consider.

My own research and writing skills were honed decades ago when I was concentrating on academic work in psychology and educational administration. Despite repeated urging from professors and advisors to write for publication, I decided to focus my energies on then-current family and professional responsibilities, blissfully unaware of the changes that were already taking place in my own brain, and whose effects on my personal and professional competency would range from subtle to profound. I was in my early fifties, slightly overweight, but with blood pressure and all metabolic markers well within normal limits. My only health concerns were allergy-induced asthma and recurrent bronchitis and pneumonia during Upstate NY winter months.

The opportunity to work at the same academic level in Florida arose in 1997, and my allergy and asthma symptoms subsided dramatically. Then, MRI following a 2001 automobile accident revealed the presence of small lacunar infarcts in the putamen and corona radiata. I was 61. Neuropsychological assessment in subsequent years demonstrated striking discrepancies (>2 SD's) between verbal and performance scores, and a diagnosis of major depression accompanied bilateral knee arthroscopies to remove and repair meniscal tissues torn in a serious fall and what seemed a never-ending cascade of physical, neurological, and psychological challenges. Problems with balance, vision, incontinence (both urinary and fecal), bradyphrenia, fluctuating blood pressure changes, short-term memory, and functional ADLs developed with varying levels of severity. And as physicians, neurologists, and psychologists considered - and then ruled out - possible explanations including NPH and Binschwanger's syndrome, my research kept pace, with corresponding growth in my understanding of the conditions and diseases that I didn't have.

Finally, in 2004, there was a consensus that the most likely cause for my complex symptomatology was MCI/Early AD with unrelated physical conditions. By this time, the efforts to perform my professional responsibilities were exhausting, and I was able to take advantage of an early retirement opportunity and return from eight years working in Florida to live closer to family members in Upstate New York. Circulatory complications from my arthroscopies led to my arrival in NYS with both legs Unna booted, and I also enrolled in a local NIH study on detecting early AD via newly-developed 3-T MR technologies. On six-month follow-up, the study director determined that my imaging data was inconsistent with early AD, and I was dismissed from the study because - as he expressed it - my situation was too complicated to continue in the study as a control. He did offer the opinion that my symptoms might be the result of pseudodementia, a term I first considered perjorative.

Fortunately, I was being seen for med management by a psychiatric senior resident whose supervisor was closely attuned to the mind-body continuum. In response to the stress of once again entering the Twilight Zone of not knowing what was happening to my mind/brain, we developed a therapeutic relationship that was warm, trusting, and mutually respectful. My persistent need to validate my experiences and understanding with research was met with patience, understanding, and encouragement to develop trust in my own judgement, and to resume writing - both for my own benefit, and possibly that of others.

In January of 2007, a serious and drawn-out respiratory infection and recurrent Fe-deficiency anemia led to a new series of tests - pulmonary, gastroenterology, and a sleep study. (I am currently scheduled for a C-PAP follow-up to the initial sleep study.) Then, in May, a serious assault resulted in hearing loss, and MRI was used to rule out permanent acoustic damage, also providing up-to-date images of my white matter changes for comparison to earlier baseline images.

It is far too soon to assess the degree to which Shroder and O'Hara's research will benefit my own situation, but I am planning to provide copies of their paper to my primary physician and pulmonologist, as well as the psychiatrist whose predecessor was so important to my understanding and acceptance of my condition. My high level of cognitive reserve will not offset my increasing WMCs forever, and I am resolved to make the most of my remaining productive time, both for myself and for others dealing with similarly confusing and frustrating challenges. MB

Competing interests

I have no competing interests or obligations. MB

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Comments(1)

Depression and Obstructive Sleep Apnea (OSA)

Schroder and O'Hara's Depression and Obstructive Sleep Apnea: An Informed Lay Perspective