The impact of atypical antipsychotic use on obstructive sleep apnea: A pilot study and literature review

Department of Psychiatry, Dartmouth Medical School, Hanover, NH, USA.
Sleep Medicine (Impact Factor: 3.15). 06/2011; 12(6):591-7. DOI: 10.1016/j.sleep.2010.12.013
Source: PubMed


Limited evidence links atypical antipsychotics (AAs) use to sleep related respiratory dysfunction and greater severity of obstructive sleep apnea (OSA). The present paper reviews the published evidence and examines the impact of AA use on the presence and severity of OSA among subjects with clinically suspected OSA after adjusting for several confounds.
Archives of the University of Iowa Sleep Laboratory from 2005 to 2009 were searched for patients using AAs at the time of diagnostic polysomnogram (PSG). PSG data of the 84 AA users with heterogeneous psychiatric disorders (of these 20 diagnosed only with depression) were subsequently compared to PSG data of two randomly selected, non-AA user groups from the same patient pool: (i) 200 subjects with a depressive disorder as the only psychiatric diagnosis, and (ii) 331 mentally healthy controls. PSG data were analyzed adjusting for known demographic, medical, and psychiatric risk factors for OSA.
Prevalence and severity of OSA did not differ significantly across three groups. Sex, age, body mass index (BMI), and neck circumference (NC) independently predicted OSA. Odds ratio for OSA in the subset of AA users carrying the diagnosis of depression (n=20) compared with subjects without mental illness was 4.53 (p<.05). By contrast, AA users without depression or those with multiple psychiatric diagnoses including depression did not show a statistically significantly elevated OSA risk.
AA use in subjects with depression appears to increase the risk of OSA after controlling for known predisposing factors.

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    • "Inclusion of this information would have given a better picture of OSA in psychiatric patients. However, in previous studies in psychiatric patients, neck circumference either was not associated with OSA (Kelly et al., 2013), or was not an important predictor in models that included BMI (Shirani et al., 2011; Anderson et al., 2012). We are not aware of any study in psychiatric patients that has included data on upper airway structure or visceral obesity, and nocturia has been assessed only in trauma patients (Krakow et al., 2006). "
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