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What the Electroconvulsive Therapy Practitioner Needs to Know About Obstructive Sleep Apnea

McCall, W. Vaughn MD, MS*; Arias, Lorraine MD; Onafuye, Rasheed MD, MPH*; Rosenquist, Peter B. MD*

doi: 10.1097/YCT.0b013e31817144a6

Obstructive sleep apnea (OSA) is common and increasingly so in countries experiencing an epidemic of obesity. The rate of OSA is likely as high or higher in psychiatric patients and patients receiving electroconvulsive therapy (ECT) as compared with the general population. Obstructive sleep apnea can be detected by maintaining a high degree of suspicion in patients with risk factors, symptoms, and typical physical findings. Failure to detect OSA can lead to serious long-term problems with cardiovascular health, excessive sleepiness, and increased risk of motor vehicle accidents. It is unknown whether failure to treat OSA could promote failure to respond to ECT or greater cognitive problems with ECT, but failure to recognize and manage the risk for OSA in patients receiving ECT might expose them to anesthetic difficulties. Ideally, patients with suspected OSA should have a sleep laboratory evaluation and a definitive treatment plan in place before ECT, but, sometimes, psychiatric urgency and lack of access to resources in developing countries would make this unworkable. At a minimum, steps can be taken during the ECT procedure to manage airway obstruction in suspected or known patients with OSA.

From the Departments of *Psychiatry and Behavioral Medicine and †Anesthesia, Wake Forest University Health Sciences, Winston-Salem, N.C.

Received for publication November 28, 2007; accepted February 8, 2008

Reprints: W. Vaughn McCall, MD, MS, Department of Psychiatry and Behavioral Medicine, Wake Forest University Health Sciences, Winston-Salem NC 27157 (e-mail:

© 2009 Lippincott Williams & Wilkins, Inc.