Gupta, Madhulika A.

Pur, Daiana R.

English

Scholarship@Western

Western University Scholarship@Western Paediatrics Publications Paediatrics Department 9-15-2018 Obstructive sleep apnea severity in dissociative identity disorder can vary significantly depending upon the autonomic activation status of the personality that has executive control Madhulika A. Gupta Schulich School of Medicine & Dentistry, mbgupta@uwo.ca Daiana R. Pur Schulich School of Medicine & Dentistry Follow this and additional works at: https://ir.lib.uwo.ca/paedpub Citation of this paper: Gupta, Madhulika A. and Pur, Daiana R., "Obstructive sleep apnea severity in dissociative identity disorder can vary significantly depending upon the autonomic activation status of the personality that has executive control" (2018). Paediatrics Publications. 2252. https://ir.lib.uwo.ca/paedpub/2252 1633Journal of Clinical Sleep Medicine, Vol. 14, No. 9 September 15, 2018Gandotra and colleagues1 have presented an interesting case of a woman with dissociative identity disorder (DID) (previ-ously multiple personality disorder), and mild obstructive sleep apnea (OSA) treated with continuous positive airway pressure (CPAP) where adherence to CPAP was dependent upon certain personalities that decided her CPAP use. The authors report daily CPAP data and the dominant personalities, observed prospectively over 7 months. “Mrs. B” (present 88% of time, treatment-adherent personality) and “Mrs. C” (present 4% of time, treatment nonadherent personality) were the dominant personalities with the remaining 4 personalities present 8% of the time in total.1 The summary of usage (h/night) and apnea-hypopnea index (AHI) (events/h) by personality indicated the following: as expected, the mean ± standard deviation (SD) usage by “Mrs. B” of 4.92 ± 1.6 h/night was significantly (P < .000001, Figure 21) greater than the mean ± SD usage of 0.96 ± 2.15 h/night by “Mrs. C”. However the mean ± SD AHI of 1.07 ± 0.7 events/h associated with “Mrs. B” who was CPAP-adherent was not significantly different (P = .15, Figure 21) from the mean ± SD AHI of 0.67 ± 0.9 events/h as-sociated with “Mrs. C” who was CPAP nonadherent.The prevalence of DID in the United States is about 1.5%.2 The core feature of DID is the presence of two or more distinct personality states that exchange executive control over the be-havior of the individual.2,3 The different personalities in DID that embody complex dissociated states of consciousness also demonstrate physiological differences1 including different levels of autonomic nervous system (ANS) reactivity and arousal.3,4 The varying levels of ANS arousal embodied by the different personalities in DID can theoretically affect the AHI wherein higher levels of arousal can lead to greater ventilatory instabil-ity5 and a higher AHI. “Mrs. B” was significantly (P < .000001, Figure 21) more adherent to CPAP than “Mrs. C”, although the AHI values were not significantly different (P = .15, Figure21) between the two personalities, suggesting perhaps that the baseline AHI (not reported1 for the individual personalities) for “Mrs. C” may have been much lower than for “Mrs. B.” Even though physically both “Mrs. B” and “Mrs. C” shared the same LETTERS TO THE EDITORObstructive Sleep Apnea Severity in Dissociative Identity Disorder can Vary Significantly Depending Upon the Autonomic Activation Status of the Personality That Has Executive ControlComment on Gandotra et al. Dissociative identity disorder CPAP adherence: an uncommon factor in obstructive sleep apnea. J Clin Sleep Med. 2018;14(4):693–695.Madhulika A. Gupta, MD, MSc, FAASM, RST; Daiana R. Pur, BMScDepartment of Psychiatry, Schulich School of Medicine and Dentistry, University of Western Ontario, London, Ontario, Canadapii: jc-18-00376 ht tp://dx.doi.org/10.5664/jcsm.7356body, differences in their levels of autonomic activation could have contributed to variations in their AHI, a factor that has important implications in the management of OSA in DID.CITATIONGupta MA, Pur DR. Obstructive sleep apnea severity in disso-ciative identity disorder can vary significantly depending upon the autonomic activation status of the personality that has ex-ecutive control. J Clin Sleep Med. 2018;14(9):1633.REFERENCES1. Gandotra K, Golish J, Rosenberg C, Strohl K. Dissociative identity disorder CPAP adherence: an uncommon factor in obstructive sleep apnea. J Clin Sleep Med. 2018;14(4):693–695.2. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 5th ed. Arlington, VA: American Psychiatric Association; 2013.3. Putnam FW, Zahn TP, Post RM. Differential autonomic nervous system activity in multiple personality disorder. Psychiatry Res. 1990;31(3):251–260.4. Reinders AA, Willemsen AT, Vos HP, den Boer JA, Nijenhuis ER. Fact or factitious? A psychobiological study of authentic and simulated dissociative identity states. PLoS One. 2012;7(6):e39279.5. Eckert DJ, White DP, Jordan AS, Malhotra A, Wellman A. Defining phenotypic causes of obstructive sleep apnea. Identification of novel therapeutic targets. Am J Respr Crit Care Med. 2013;188(8):996–1004.SUBMISSION & CORRESPONDENCE INFORMATIONSubmitted for publication June 17, 2018 Submitted in final revised form June 17, 2018 Accepted for publication June 22, 2018Address correspondence to: Dr. M. A. Gupta, 585 Springbank Drive, Suite 101, London, Ontario, Canada, N6J 1H3; Tel: 519-641-1001; Fax: 519-641-1033; Email: magupta@uwo.ca, magupta1@gmail.comDISCLOSURE STATEMENTAll authors have seen and approved the manuscript. The authors report no conflicts of interest.Downloaded from jcsm.aasm.org by 207.136.114.76 on June 22, 2022. For personal use only. No other uses without permission. Copyright 2022 American Academy of Sleep Medicine. All rights reserved. 

Obstructive sleep apnea severity in dissociative identity disorder can vary significantly depending upon the autonomic activation status of the personality that has executive control

https://ir.lib.uwo.ca/cgi/viewcontent.cgi?article=3260&context=paedpub

Obstructive sleep apnea severity in dissociative identity disorder can vary significantly depending upon the autonomic activation status of the personality that has executive control

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