Atypical antipsychotic medications are independently associated with severe obstructive sleep apnea.
BACKGROUND
Atypical antipsychotic (AA) medications are widely prescribed for their Food and Drug Administration-approved uses (acute mania, bipolar mania, psychotic agitation, bipolar maintenance, etc) and off-label indications. Although AA medications are associated with substantial weight gain, their tranquilizing effects may independently contribute to risk of obstructive sleep apnea (OSA) perhaps, by a reduction in activity of hypoglossal or recurrent activity of laryngeal nerve on the upper motor airway musculature.


METHODS
We hypothesized that AA medications are associated with more severe OSA independent of weight and neck circumference. Medical intake data and polysomnographic studies of patients referred to community hospital sleep disorders center were analyzed retrospectively.


RESULTS
Mean age of patients was 49.1 years, 55.1% were male, and mean body mass index (BMI) was 33.8 kg/m. Sixty-eight patients (8.1%) were taking AA at the time of polysomnography. There were no differences in age, sex, neck circumference and BMI of AA versus non-AA patients. The mean (SE) apnea-hypopnea index values were 29.2 (3.5)/h in AA patients and 21.3 (0.8)/h in non-AA patients (P = 0.03). Thirty-four percent of AA patients had severe OSA (apnea-hypopnea index > 30/h) compared with 23% of non-AA patients (P = 0.04). When adjusted for BMI, sex, and use of benzodiazepines and sleeping aids, the odds ratios of severe OSA in AA patients were 1.9 times in non-AA patients (95% confidence interval, 1.1-3.3).


CONCLUSIONS
Atypical antipsychotic medication use may increase the risk of more severe OSA independent of weight and neck circumference.
Rishi
Muhammad Adeel
MA
Bridgeport Hospital and Yale University School of Medicine, Bridgeport, CT 06610, USA. adeelrishi@yahoo.com
Shetty
Mahesh
M
Wolff
Armand
A
Amoateng-Adjepong
Yaw
Y
Manthous
Constantine A
CA
D000328:Adult; D000375:Aging; D014150:Antipsychotic Agents / Q000009:adverse effects* / Q000145:classification / Q000627:therapeutic use; D015992:Body Mass Index; D049628:Body Size; D015331:Cohort Studies; D005260:Female; D006801:Humans; D006993:Hypnotics and Sedatives / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D009333:Neck / Q000033:anatomy & histology; D017286:Polysomnography; D011618:Psychotic Disorders / Q000150:complications / Q000188:drug therapy; D012189:Retrospective Studies; D012720:Severity of Illness Index; D012727:Sex Characteristics; D020181:Sleep Apnea, Obstructive / Q000139:chemically induced* / Q000150:complications / Q000175:diagnosis / Q000503:physiopathology; D012893:Sleep Wake Disorders / Q000150:complications / Q000175:diagnosis
D014150:Antipsychotic Agents; D006993:Hypnotics and Sedatives