Sleep Apnea Treatment Refusal, Grandiosity and Suicide

Abstract

This 47-year-old patient’s unrelenting denial of illness prevented his compliance with treatment in spite of active medical surveillance. With serious conditions such as those encountered in this case, namely bipolar disorder with psychosis, and chronic medical disorders such as obstructive sleep apnea and diabetes mellitus, continuity of care over time with the patient and physician working in alliance is key to desired outcomes. Treating providers in this case were limited to a sleep specialist and primary care nurse practitioner. Referral to a psychiatrist proved impossible. Apparently this patient’s attachment to the sleep specialist permitted him to continue office visits, although even this connection was tenuous at best and did not prevent ultimate suicide.