New Research to Help the Mentally Ill Rest Easy

Sleep disorders, particularly obstructive sleep apnoea (OSA), are common amongst people with Severe Mental Illness (SMI) and contribute to their typically poor general health and premature mortality. In addition, there are concerns that poor sleep might also exacerbate their mental illness.

Despite the potentially serious health effects, SMI patients often refuse to undergo a traditional hospital-based sleep study to diagnose whether they have OSA.

“We know that Continuous Positive Air Pressure (CPAP) therapy makes a difference to OSA but we didn’t know how feasible it was to screen the Severely Mentally Ill for the condition and treat it,” said University of Sydney Professor, Ron Grunstein, from the Woolcock Institute of Medical Research.

“The challenge was, how do you make the diagnosis in a setting where the patient is often resistant to coming into a hospital, follow-up is difficult and sometimes they are not keen on the treatment?”

In a program funded by Sydney Health Partners, a team of researchers and clinicians led by Professor Grunstein trialled a home-based diagnostic test, which uses a relatively simple and non-invasive device known as an oximeter. The device, which attaches to the patient’s wrist and finger, measures oxygen saturation in the blood during sleep.

Patients found to have a high oxygen desaturation index require a CPAP machine to treat the condition.

“It’s been a challenging project because patients with SMI are not an easy population to work with,” says project manager Paola Espinel-Diaz. “If they are cognitively well-enough they are good at following the instructions for the oximeter. But it takes longer to engage those who require CPAP therapy and they need more education about how to sleep with a CPAP machine, and closer follow-up support than people without SMI.”

Espinel-Diaz says researchers were pleasantly surprised by the high level of adherence amongst patients in the trial to date.

“Of the patients who consented to take part in the trial, 90% have completed oximetry. And amongst those who commenced CPAP therapy, the proportion who persisted with the treatment was actually similar to the broader population.”

“I think that’s because people understand this therapy will benefit their overall health. And when they experience a result from the treatment – they feel fantastic and have more energy.”

The sleep apnoea project is part of a longer-standing initiative at Sydney Local Health District called the Collaborative Centre for Cardiometabolic Health in Psychosis (ccCHiP), which is an interdisciplinary collaboration in clinical research involving Psychiatry, Cardiology, Endocrinology, Dentistry, Sleep Medicine and Allied Health clinicians.

ccCHiP Director and Sydney Health Partners’ Mental Health Stream lead, Professor Tim Lambert, says the centre uses a multi-disciplinary integrated health approach to improve the life expectancy of the Severely Mentally Ill, who typically die up to 30 years earlier than the population average.

“With most SMI patients we are dealing with multiple co-morbidities and usually all of them are chronic. The challenge is not just screening and diagnosis – it’s  finding ways to help ensure this vulnerable group of people are enabled to undertake the things we’ve prescribed or agreed with them to do,” said Professor Lambert.

“But we’ve found that if we talk about – and demonstrate through interactive visualisations - their cardiovascular health in terms of the difference between their biological age and the apparent age of their heart, they appear to immediately understand it. For those who have completed six weeks or more of CPAP we can show them that they’ve reduced their ‘heart age’ or cardiovascular risks. To see a significant change in such a short time is very promising.”