Rapid resolution of intense suicidal ideation after treatment of severe obstructive sleep apnea

Patients with insomnia may develop suicidal ideation; however, we know of no reports of suicidal ideation associated with obstructive sleep apnea. We report on a 74-year-old man who presented to his primary care physician with excessive daytime sleepiness, poor quality nocturnal sleep, depressed mood, and suicidal ideation with active suicide plans. An emergency outpatient psychiatry consultation was arranged. The patient declined psychiatric hospitalization. He agreed to a trial of continuous positive airway pressure, using a self-titrating machine, followed by an urgent sleep study. Polysomnography revealed an apnea hypopnea index of 64, arousal index of 91 and minimum oxygen saturation of 65%. The patient's sleep and excessive daytime sleepiness responded to nCPAP. The patient declined antidepressant medication but had excellent adherence to nCPAP. Suicidal ideation and depression resolved promptly and at 4-month followup were in remission. Further studies examining the relationship among untreated obstructive sleep apnea, depression, and suicidal ideation are warranted.