Antipsychotic Medication and Sleep Apnea: Study Finds Both Benefits and Risks

A recent study has identified potential benefits and risks associated with using an antipsychotic medication for obstructive sleep apnea (OSA). Published in the Annals of the American Thoracic Society, the research conducted by Flinders University in Adelaide, Australia, examined the effects of quetiapine on sleep apnea and subsequent driving impairment.

The study included 15 adult participants with OSA who had difficulty maintaining sleep. Each participant underwent two sleep studies spaced approximately one week apart. During one study, they received a 50mg dose of quetiapine before bed, and during the other, they took a placebo.

Quetiapine, known as Seroquel, is commonly prescribed for conditions such as schizophrenia, bipolar disorder, and depression. It is also used off-label for issues like insomnia and anxiety.

Results showed that participants experienced an increase in total sleep time by over 40 minutes and a significant reduction in apnea-related events, from 27 to 20 events per hour, when taking quetiapine compared to the placebo.

However, there were concerning findings regarding driving abilities. A driving simulator and a reaction test exposed quetiapine’s negative impact on reaction times. Participants had more attention lapses and a higher propensity to swerve out of lanes, indicating impaired driving abilities.

Eleven of the 15 participants felt sleepier the following morning after taking quetiapine, yet one in four were unaware of their level of impairment, presenting a potential risk when operating vehicles or machinery.

Side effects such as nausea, restless legs, and a drop in blood pressure upon standing were observed, affecting about one in three individuals taking quetiapine.

The study’s limitations included its small sample size and short-term evaluation. The authors emphasized the need for larger, long-term studies to substantiate these findings before prescribing quetiapine for sleep apnea and insomnia.

Researchers recommend avoiding driving or performing safety-critical tasks for at least 9.5 hours after taking quetiapine.

Women metabolize the medication more slowly than men, potentially affecting efficacy and risks of side effects, according to expert Ashley Curtis, PhD., from the University of South Florida.

Curtis noted the importance of understanding the trade-offs between sleep benefits and daytime cognitive function, particularly among older adults who may already be vulnerable to cognitive side effects due to polypharmacy.

Behavioral interventions such as cognitive behavioral therapy for insomnia remain crucial despite medications’ short-term effectiveness, Curtis stated.

Chelsie Rohrscheib, head sleep expert at Wesper, recommends patients discuss their treatment options with healthcare providers, considering the risks and benefits of using quetiapine for sleep.