The impact of atypical antipsychotic use on obstructive sleep apnea: a pilot study and literature review.
ABSTRACT 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.
- SourceAvailable from: Mary V. Seeman[Show abstract] [Hide abstract]
ABSTRACT: Abstract Background: Obstructive sleep apnoea (OSA) is often overlooked in the context of schizophrenia because its hallmark, daytime sleepiness, is so easily attributable to antipsychotic drugs. This is a special problem for women. Aims: To underscore the importance of diagnosing and treating OSA in women with schizophrenia. Methods: A review of the recent literature (search terms: Obstructive Sleep Apnoea; Schizophrenia; Women (or Gender); Obesity; Antipsychotics; Continuous Positive Airway Pressure (CPAP)) as it applies to a composite case vignette taken from the files of a specialty clinic that treats women with psychosis. Results: The rate of OSA in women who are both obese and postmenopausal is very similar to that of men. Family history, smoking, and the use of tobacco, alcohol and of antipsychotic medication increase the risk. Despite reluctance, patients with schizophrenia generally agree to undergo sleep studies. Compliance with CPAP is difficult, but can be aided by the physician and is, on the whole, relatively high in women. CPAP improves sleep parameters and may also improve cardiometabolic and cognitive indices, although this still needs to be more fully researched. Conclusion: Schizophrenia and untreated OSA are both associated with high mortality rates in women as well as men.Journal of Mental Health 01/2014; 23(4):191-196. DOI:10.3109/09638237.2013.869572 · 1.01 Impact Factor
- [Show abstract] [Hide abstract]
ABSTRACT: Sleep respiration is regulated by circadian, endocrine, mechanical and chemical factors, and characterized by diminished ventilatory drive and changes in Pao2 and Paco2 thresholds. Hypoxemia and hypercapnia are more pronounced during rapid eye movement. Breathing is influenced by sleep stage and airway muscle tone. Patient factors include medical comorbidities and body habitus. Medications partially improve obstructive sleep apnea and stabilize periodic breathing at altitude. Potential adverse consequences of medications include precipitation or worsening of disorders. Risk factors for adverse medication effects include aging, medical disorders, and use of multiple medications that affect respiration.Clinics in Chest Medicine 09/2014; DOI:10.1016/j.ccm.2014.06.011 · 2.17 Impact Factor
- [Show abstract] [Hide abstract]
ABSTRACT: Objective: Despite the high prevalence of sleep disturbances in patients with co-occurring schizophrenia and substance use disorders, very little is known about sleep in this population. This paper reviews the existing literature on sleep in patients with schizophrenia and substance use disorders. Methods: PubMed and Ovid searches were performed using combinations of the terms “sleep,” “schizophrenia,” and names of commonly abused individual substances. Since searches regarding sleep in patients with dual diagnoses returned few results, we also explored the sleep abnormalities inherent in schizophrenia and in substance use disorders separately. Results: Our search identified 1,667 papers and 111 were included for review. We summarized what little is known about primary sleep disorders in this population and identified commonalities in sleep disturbances in each disease with emphasis on underlying pathophysiology as well as the effects of antipsychotics. Conclusions: Given the high prevalence of sleep abnormalities in patients with schizophrenia and substance use disorders, the relative paucity of clinical guidance, and the potential impact that sleep disorders can have on the course of disease, there is a need for additional research regarding sleep in patients with co-occurring schizophrenia and substance use disorders to improve recognition and management of these comorbid conditions.Journal of Dual Diagnosis 08/2013; 9(3):228-238. DOI:10.1080/15504263.2013.806088 · 0.80 Impact Factor