Abstract

Introduction

Psychiatric illness is an important potential cause of excessive daytime sleepiness (EDS), hypersomnia, and narcolepsy-like symptoms. We report a case of hypersomnia and pseudo-cataplexy associated with schizoaffective disorder.

Report of Case

A 28-year-old man with obstructive sleep apnea (OSA) and schizoaffective disorder presented to our sleep medicine clinic complaining of EDS, cataplexy-like attacks, sleep paralysis, depressed mood, and dream intrusion. Questions about cataplexy often provoked brief episodes of speech arrest, eye closure, and neck flexion lasting a few seconds.An MSLT with CPAP showed a mean sleep latency of 3 minutes and 3 sleep onset REM periods (SOREMPs); however, actigraphy showed that the SOREMPs occurred during the patient’s habitual sleep period and the patient discontinued a REM-suppressing medication within a few days of the study. The HLA-DQB1*0602 allele was absent.Following circadian adjustment, a repeat MSLT with CPAP showed zero sleep and no SOREMPs. The preceding polysomnogram showed a total sleep time (TST) of 7.8 hours, no epileptiform activity, adequately-treated OSA, and a REM latency of 53 minutes. Prior to these studies, two weeks of sleep diary and actigraphy showed a TST greater than 10 hours. Ultimately, treatment of the patient’s psychiatric disorder resulted in a reduction of his EDS and TST.

Conclusion

Patients with psychiatric illness can present with hypersomnia, EDS, and narcolepsy-like symptoms such as pseudo-cataplexy. Misdiagnosing such a patient with narcolepsy can lead to treatments capable of worsening the primary underlying psychiatric disturbance. MSLT results must be interpreted in the context of a patient’s clinical history and sleep schedule; if there is concern for a false positive result, repeat testing should be considered.

中文翻译：

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1248伴有精神分裂症的假性脑瘫的失眠症：一例报告

摘要

介绍

精神疾病是导致白天过度嗜睡（EDS），失眠和发作性睡病样症状的重要潜在原因。我们报告一例伴有精神分裂性情感障碍的失眠和假性瘫痪。

案件报告

一名28岁的患有阻塞性睡眠呼吸暂停（OSA）和分裂情感障碍的男子到我们的睡眠医学诊所就诊，他们抱怨EDS，类脑瘫发作，睡眠麻痹，情绪低落和梦dream以求。关于瘫痪症的问题通常会引起短暂的言语发作，闭眼和颈部屈曲持续数秒钟。MSCP伴CPAP的平均睡眠潜伏期为3分钟，睡眠开始为快速眼动（REM）期3次。然而，体动记录显示，SOREMP发生在患者的习惯性睡眠期间，并且患者在研究的几天内中止了REM抑制药物。缺少HLA-DQB1 * 0602等位基因。在昼夜节律调整后，重复进行CPLT的CPLT显示零睡眠且无SOREMP。先前的多导睡眠图显示总睡眠时间（TST）为7.8小时，没有癫痫样活动，经过充分治疗的OSA，REM潜伏期为53分钟。在进行这些研究之前，两周的睡眠日记和书法记录表明，TST大于10小时。最终，对患者精神病的治疗导致其EDS和TST降低。

结论

精神病患者可能会出现失眠，EDS和发作性睡病样症状，例如假性瘫痪。对这种发作性睡病患者进行误诊会导致能够加重原发性精神疾病的治疗。MSLT结果必须根据患者的临床病史和睡眠时间表进行解释；如果担心出现假阳性结果，则应考虑重复测试。