The Spousal Arousal Syndrome

Abstract & Commentary

Synopsis: CPAP treatment improves the sleep quality and daytime function of bed partners of patients with sleep apnea.

Source: Doherty LS, et al. Chest. 2003;124:2209-2214.

Doherty and colleagues report findings from surveys of bed partners of patients with newly diagnosed sleep apnea. At enrollment and prior to initiation of CPAP treatment, patients and their bed partners completed the Short Form 36 (SF-36), the hospital anxiety and depression scale (HADS), the Epworth Sleepiness Scale (ESS), and a general lifestyle questionnaire. They completed these same instruments 6-8 weeks after CPAP was started. Forty-five couples completed the study; in only 1 of these couples was the patient a woman.

The patients reported excellent CPAP use of about 7 hours a night, but this was not objectively verified. Both the patients and their bed partners had statistically significant improvements in measures of sleepiness and anxiety after treatment. Prior to treatment, both patients and their partners had significantly impaired quality of life compared to age- and gender-matched norms. In patients, there were dramatic improvements in the SF 36 domains of physical functioning, role limitation due to physical and emotional problems, social functioning, mental health, energy/vitality, and general health perception. The only domain that did not improve was pain. In partners, role limitation due to physical and emotional problems, social functioning, mental health, energy/vitality improved significantly as well.

There was a significant correlation between hours of CPAP use and improvement in energy/vitality. Sleepiness, as assessed by the ESS, correlated with several markers of impairment, including anxiety, depression, and general health perception. Of note, the only correlations seen in partners were between CPAP pressure and both depression and general health perception (CPAP pressure may be a surrogate marker for obesity). Ten couples in this study did not share a bed; for the partners in this group, sleepiness scores did not improve as much as those who did share a bed with the sleep apnea patient. However, the improvements in quality-of-life measures in this group were similar to those of the bed-sharing couples.

Comment by Barbara A. Phillips, MD, MSPH

Previous work has demonstrated that bed partners of people with sleep apnea and snoring are at increased risk for depression, insomnia, and daytime sleepiness.1-3

There are probably at least 2 reasons for this: the noise and restlessness of the patient are physically disruptive to the sleep of the bed partner, and concern about the partner’s health is emotionally disturbing. The current study, by demonstrating improvement in quality of life but not sleepiness in those partners who slept in separate beds, suggests that the consequences of sleep-disordered breathing can reach far beyond the bedroom. Indeed, divorced partners (or former partners, I guess) of sleep apnea patients are less depressed and socially isolated than those partners who are still married to the sleep apnea patient.1

This study corroborates and extends previous work showing that the benefits of CPAP extends to partners,4 although not all work in this area has been positive.5 It certainly corroborates my own experience in the Sleep Clinic, where I have learned to predict CPAP compliance by how broadly the bed partner is smiling.

The good news is that CPAP treatment greatly improves things both for the patient and for his bed partner, without any specific intervention for the bed partner. The clinical use of this is that we may be able to enlist the aid of the bed partner in encouraging CPAP compliance. And it reinforces the need to work with the couple, not just the patient, in dealing with sleep disorders.

Dr. Phillips, Professor of Medicine, University of Kentucky; Director, Sleep Disorders Center, Samaritan Hospital, Lexington, KY, is Associate Editor of Internal Medicine Alert.

References

1. Cartwright RD, Knight S. Sleep. 1987;10:244-248.

2. De Waterman AL, Kerkjof G. Percept Mot Skills. 1998;86:1141-1142.

3. Ulfberg J, et al. Health Care Women Int. 2000;2:81-90.

4. Beninati W, et al. Mayo Clin Proc. 1999;74:955-958.

5. McArdle N, et al. Thorax. 2001;56:513-518.