Prevalence and pattern of sleep disorders in psychiatric disorders in north Indian population

 

 

Abstract               Background: Sleep disorders and psychiatric illness are closely related, with different clinical manifestations. They have complex bi-directional association. Hence attempt was made to understand both of these conditions so that such patients can be treated in better way. Method: This was a cross-sectional study using purposive sampling technique on one hundred (100) patients aged between 18 to 45 years attending Psychiatry OPD of RMRI, Bareilly. A semi-structured proforma was used for Socio-demographic data patients. Psychiatric diagnosis was made using ICD-10 diagnostic and research criteria. Pittsburgh Sleep Quality Index (PSQI) was used to evaluate for sleep problems. Appropriate statistical tests were applied and data was analysed using SPSS software. They had sleep disorders like, difficultly in falling sleep, maintaining sleep waking early in the morning, occurrence of non-freshen sleep. During psychiatric counseling, types of sleep and diagnostic features of various psychiatric illnesses were also noted. Results: Types of sleep disorders were -48 Insomnia, 11- Hypersonic, 25-parasonmina, 9- circadian sleep disorder, 7-had PLMD. The diagnostic futures were -28 had mood disorders, 13-had loss of interest or pleasure in any activities -7 change in appetite, 6- had fatigue, 15-had feeling of guilt or worthiness, 14-hadpoor concentration or difficulty in making decision, 17 had suicidal ideation. Associated clinical manifestations were -19 had major depression, 11 had generalized anaexiety7-had paranoid reaction, 9- had hallucinations 13-had delusion, 4- had post-traumatic stress disorder, 12 had grandeur neurosis, 13 had bipolar mood disorder, 12- were alcoholic. Conclusion: This pragmatic approach to the psychiatric patients will be quite helpful to treat efficiently because the sleep disturbances particularly, insomnia has been considered in assessment of suicidal risk with depressive disorders.

Key Words:-Insomnia, Major Depression, PLMD- Periodic Limb Movement Disorder, Parasomnia, Generalized Anxiety Disoder.

 

 

INTRODUCTION

Sleep is an important biological mechanism which is vital for daily healthy functioning. Sleep disorders are frequently associated with a wide range of psychiatric illnesses and both have a complex bi-directional association. Persistent insomnia can be an associated symptom or an independent risk factor for Depression, anxiety disorders, bipolar disorders, alcohol and substance abuse, suicide, psychotic disorders and treatment of either of insomnia or psychiatric disorders have better treatment outcomes for each of them especially, depression and anxiety. Depressed patients often report inadequate or non-restorative sleep, as well as difficulty in falling sleep frequent nocturnal and early morning awakening decreased total sleep and disturbing dreams.^1,2 Sleep-related complaints and electroencephalography (EEG) changes are generally encountered in, psychiatric disorders. Sleep complaints such as insomnia, hypersomnia and night mares³ and Rapid eye movements (REM) sleep disturbances are associated sleep disturbances in psychiatric disorders like major depressive disorders, bipolar disorders, generalized anxiety, post traumatic stress, schizophrenia (psychosis) and alcoholism , Suicidality and hallucination⁴. Sleep deprivation aggravate psychiatric illness and many of such patients can have suicidal ideation and attempt for suicide also. Untreated sleep disorders can lead to increased risk and exacerbation of exixsting medical disorders like, cardiovascular disorders, hypertension, stroke, obesity and sexual dysfunction. Hence this study was conducted to evaluate the prevalence and pattern of sleep disorders in adult patients of either sex of various psychiatric disorders in North Indian population attending the Psychiatry OPD of a medical college hospital.

 

MATERIAL AND METHODS

Method- This was a cross- sectional study using purposive sampling technique on one hundred (100) patients aged between 18 years to 45 years regularly visiting, Psychiatry OPD of Rajshree Medical Research Institute (RMRI) Hospital, Bareilly. Semi-structured proforma was used for socio-demographic details of the patients. Psychiatric diagnosis was made using clinical interview and International Classification of Disease (ICD-10), WHO,1990 research and diagnosed criteria. Pittsburgh Sleep Quality Index (PSQI, 1989) was used to evaluate for sleep disorders like, Insomnia, Hypersomnia, Parasomnia or Episodic disturbances in sleep (Night terror, night mares, somnambulism, sleep talking, bruxisum etc). The duration of study was 12 months between September 2017 to September 2018).

Inclusion criteria-

1. Adult patients of either sex with age group 18 years to 45 years.
2. Patients giving written and informed consent.

Exclusion criteria –

1. Patients having clinically observable severe mental retardation
2. Patients having severely compromised medical conditions like Diabetes, stroke, hypertension, myocardial infarction.

Statistical analysis- The prevalence of sleep disorders in psychiatric disorders was analysed using percentages. The ratio of male and female were 2:1. Data was analysed using SPSS computer software.

 

OBSERVATION AND RESULTS

Table-1 – Study of types of sleep disorders in psychiatric disorder patients -48 (48%) Insomnia, 11 (11%)- hypersomnia, 25 (25%) parasomnia (included 5- had night terrors, 7 had night mares, 6 had somnambulism, 4 had sleep talking , 3 had bruxism), 9 (9%) had circadian sleep disorders, 7 (7%) had PLMD( Periodic limb movement disorder). 

 

Table 1: Study of types of Sleep disorders in Psychiatric disorder patients (No. of patients 100)

Table-2 – Psychiatric symptoms in patients having sleep problems – 28 (28%) had mood disturbances, 13 (13%) had loss of interest or pleasure in activities, 7 (7%) had change in appetite, 6 (6%) had fatigue, 15 (15%) had feeling of guilt or worthiness, 14 (14%) had poor concentration or difficulty in making decision, 17 (17%) had suicidal ideation.

 

Table 2: Diagnostic features of sleep disorders in Psychiatric disorder patients    (No of patients 100 )

Table-3- Associated Psychiatric disorders- 19 (19%) had major depression, 11 (11%) had generalized anxiety, 7 (7%) had psychosis (paranoid), 9 (9%) had hallucinations, 13 (13%) had delusion, 14 (14%) had post traumatic stress disorder, 12(12%) had mania, 13(13%) had bipolar mood disorder, 12(12%) were alcohol dependent.

 

Table 3: Associated clinical Psychiatric disorders with sleep disorders       (No of patients- 100)