{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,7]],"date-time":"2026-02-07T04:16:14Z","timestamp":1770437774804,"version":"3.49.0"},"reference-count":34,"publisher":"Wiley","issue":"7","license":[{"start":{"date-parts":[[2013,8,27]],"date-time":"2013-08-27T00:00:00Z","timestamp":1377561600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Bipolar Disorders"],"published-print":{"date-parts":[[2013,11]]},"abstract":"<jats:sec><jats:title>Objective<\/jats:title><jats:p>In this case report we present our clinical observations of two patients with bipolar disorder with comorbid obstructive sleep apnea (<jats:styled-content style=\"fixed-case\">OSA<\/jats:styled-content>) who were treated with continuous positive airway pressure (<jats:styled-content style=\"fixed-case\">CPAP<\/jats:styled-content>) for their sleep apnea.<\/jats:p><\/jats:sec><jats:sec><jats:title>Background<\/jats:title><jats:p>Bipolar disorder is a psychiatric disorder characterized by the presence of one or more episodes of mania and frequent episodes of depression. This disorder affects approximately 0.8% of the adult population, with estimates from community samples ranging between 0.4% and 1.6%. <jats:styled-content style=\"fixed-case\">OSA<\/jats:styled-content> syndrome is a severe sleep disorder with a prevalence of 2\u20134% in the general population, the risk of which is increased by obesity. The prevalence of <jats:styled-content style=\"fixed-case\">OSA<\/jats:styled-content> is expected to be high in bipolar disorder due to high comorbid obesity. It is expected that improvement in <jats:styled-content style=\"fixed-case\">OSA<\/jats:styled-content> in patients with bipolar disorder with <jats:styled-content style=\"fixed-case\">CPAP<\/jats:styled-content> will improve mood and other symptoms of bipolar disorder. However, there is a relative lack of data examining this aspect.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>In both cases of bipolar disorder, <jats:styled-content style=\"fixed-case\">CPAP<\/jats:styled-content> was started after a polysomnographic diagnosis of <jats:styled-content style=\"fixed-case\">OSA<\/jats:styled-content> and <jats:styled-content style=\"fixed-case\">CPAP<\/jats:styled-content> titration study indicating that most of the apneas\/hypopneas were eliminated with a significant improvement in oxygen saturation. To our surprise, we noted that in both of these cases initiation of <jats:styled-content style=\"fixed-case\">CPAP<\/jats:styled-content> resulted in manic symptoms.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Clinicians need to monitor patients with bipolar disorder closely for worsening of manic symptoms when they are started on <jats:styled-content style=\"fixed-case\">CPAP<\/jats:styled-content> for underlying <jats:styled-content style=\"fixed-case\">OSA<\/jats:styled-content>.<\/jats:p><\/jats:sec>","DOI":"10.1111\/bdi.12112","type":"journal-article","created":{"date-parts":[[2013,8,27]],"date-time":"2013-08-27T06:35:09Z","timestamp":1377585309000},"page":"803-807","source":"Crossref","is-referenced-by-count":12,"title":["CPAP\u2010induced mania in bipolar disorder: a case report"],"prefix":"10.1111","volume":"15","author":[{"given":"Richa","family":"Aggarwal","sequence":"first","affiliation":[{"name":"Department of Psychiatry Penn State Milton S. Hershey Medical Center Hershey PA USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Raman","family":"Baweja","sequence":"additional","affiliation":[{"name":"Department of Psychiatry Penn State Milton S. Hershey Medical Center Hershey PA USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Erika FH","family":"Saunders","sequence":"additional","affiliation":[{"name":"Department of Psychiatry Penn State Milton S. Hershey Medical Center Hershey PA USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ravi","family":"Singareddy","sequence":"additional","affiliation":[{"name":"Department of Psychiatry Penn State Milton S. 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