February 02, 2012

Not sure how to counsel your patients with obstructive sleep apnea about surgery? You might want to share the results of this study.

After multiple patients had surgery and reported anecdotal changes in dream content, recall, and sexual activity, Dr. J. Drew Prosser and his colleagues at Georgia Health Science University in Augusta decided to find out more.

Courtesy Wikimedia Commons/Metropolitan Museum of Art/Public Domain "A Woman Asleep at Table" by Johannes Vermeer

They asked 30 obstructive sleep apnea patients to complete a questionnaire about dreams and sex before and after their surgery. “We found changes in dream and nightmare recall, as well as changes in sexual activity, occurs in a significant number of patients,” Dr. Prosser said.

Of the 46% who reported a significant change in dream recall, the majority (72%) remembered more after surgery. In addition, the dreams were better: 24% said they remembered fewer nightmares.

Sexual function was more mixed – half of the 25% who reported a major change said their sexual function improved while the other half said it worsened.

“We believe preoperative counseling in these unintended consequences is warranted,” Dr. Prosser said at The Triological Society Combined Sections Meeting on Miami Beach. Dr. Prosser is a PGY4 resident in otolaryngology at Georgia Health Science University. www.georgiahealth.edu/otolaryngology/residents/current_residents.html

Participants were mostly middle aged men (mean age, 44 years; 17% were women). Surgery was considered because these patients were unable to tolerate continuous positive airway pressure (CPAP) therapy. CPAP and weight loss remain the treatments of choice, Dr. Prosser said.

“Overall, surgery is effective in improving energy and improving CPAP compliance in patients with obstructive sleep apnea,” Dr. Prosser said. Postoperatively, 63% noted improved daytime energy and CPAP use improved 24%. Other notable findings: 58% of patients reported a change in sleep position and 42% reported breathing better day and night.

So what’s the connection? It’s not clear, but these findings support a couple of theories. The patients who reported remembering significantly more dreams after surgery started with the most severe apnea preoperatively. This supports the idea that fragmentation of sleep causes cognitive dysfunction and short term memory deficits, which would lead to decreased dream recall, Dr. Prosser said. Another theory is surgery permits patients to spend more time in REM sleep, a period when people typically dream but often decreased on polysomnography for people with more severe apnea.

“Interestingly, nightmare recall decreased in patients with significant hypoxia (low oxygen) preoperatively and improved postoperative parameters. This leads us to believe that hypoxia may play a role in the negative content of dreams,” Dr. Prosser said.

--Damian McNamara (@MedReporter on Twitter)

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