Obstructive Sleep Apnea with Secondary Depression and Irritability Treated with Trazodone and Pregabalin

Depression, irritability and fibromyalgia have been linked to obstructive sleep apnea (OSA) which in turn presents with decreased slow wave sleep, the sleep phase responsible for cerebral recovery and consolidation of sleep. Pregabalin increases slow wave sleep and sleep efficiency; while simultaneously combining mood stabilizing properties, being a theoretical therapeutic option for the psychiatric complications of OSA. Case report of a patient with full remission of a major recurrent depressive disorder and resistant insomnia after treatment with Pregabalin; bibliographic search using PubMed/MedLine database with the following keywords: mood disorder; personality disorder; obstructive sleep apnea; pregabalin. We report and discuss the case of a 63-year-old woman with a history of major recurrent depressive disorder, histrionic personality disorder and chronic resistant insomnia. The patient presented with chronic widespread pain, nonspecific somatic complaints, depressive mood and chronic resistant insomnia. After several unsuccessful treatment trials with Venlafaxine, benzodiazepines and Zolpidem; the patient presented slight relief of depressive mood with Trazodone (150mg/day). Complete resolution of all disorders was obtained following adjunctive therapy with Pregabalin (50mg/day). Polysomnography revealed severe supine apnea hypopnea index (32.1), sleep architecture fragmentation, global efficiency of 57%; with an increased slow wave sleep of 33%. The patient was referred to sleep apnea consultation and remains asymptomatic. Our case suggest that Pregabalin may be useful in the treatment of several psychiatric conditions secondary to OSA. Literature revision suggests theoretical mechanisms that could explain the underlying mechanisms of this therapeutic effect such as increased slow wave sleep.