title: Atypical antipsychotics for insomnia: a systematic review.
abstract: Observational evidence suggests that atypical antipsychotics such as quetiapine are increasingly being used to manage insomnia. This is concerning given the uncertain efficacy and potential adverse effects associated with these medications.
  
  
  
  The objectives of this study are to evaluate the benefits and adverse effects of atypical antipsychotics used specifically for insomnia.
  
  
  
  The methods used in this study are systematic review and narrative synthesis.
  
  
  
  The data were collected from PubMed; EMBASE; Cochrane Library; PsycINFO; grey literature; and the manufacturers of risperidone, quetiapine and olanzapine.
  
  
  
  Adult patients ≥18 years of age using atypical antipsychotics specifically for primary or co-morbid insomnia for ≥ 1 week were compared to those receiving active intervention or placebo.
  
  
  
  Two independent reviewers screened titles, abstracts and full-text articles; extracted data; and conducted risk-of-bias analysis. Grading of Recommendations Assessment, Development and Evaluation (GRADE) assessment was completed.
  
  
  
  One double-blind randomized controlled trial (n = 13) met the eligibility criteria. Statistically significant differences were not observed from baseline between quetiapine and placebo after 2 weeks for primary insomnia in terms of total sleep time (mean difference (MD) 52.68 min, 95% CI -27.27 to 132.6), reduction in sleep latency (MD 72.44 min, 95% CI -2.65 to 147.5) or improved sleep satisfaction measured with a visual analogue scale out of 100 (MD 6.16, 95% CI -12.32 to 24.64), despite a trend towards improved sleep parameters. The study was rated as very low quality.
  
  
  
  Very low quality evidence suggests that quetiapine does not significantly improve sleep parameters compared with placebo in primary insomnia, despite a trend towards clinical improvements. Atypical antipsychotics should be avoided in the first-line treatment of primary insomnia until further evidence is available.
authors.affiliation: School of Epidemiology, Public Health and Preventive Medicine, University of Ottawa, Ottawa, Canada; Bruyère Research Institute, Ottawa, Canada. Electronic address: wthomp01@gmail.com.
authors.forename: Wade
authors.initials: W
authors.lastname: Thompson
authors.affiliation: Canadian Agency for Drugs and Technologies in Health, Ottawa, Canada.
authors.forename: Teo A W
authors.initials: TAW
authors.lastname: Quay
authors.affiliation: School of Pharmacy, University of Waterloo, Waterloo, Canada; Schlegel-UW Research Institute for Aging, Waterloo, Canada; School of Public Health and Health Systems, University of Waterloo, Waterloo, Canada.
authors.forename: Carlos
authors.initials: C
authors.lastname: Rojas-Fernandez
authors.affiliation: Bruyère Research Institute, Ottawa, Canada; School of Pharmacy, University of Waterloo, Waterloo, Canada; Department of Family Medicine, University of Ottawa, Ottawa, Canada.
authors.forename: Barbara
authors.initials: B
authors.lastname: Farrell
authors.affiliation: School of Epidemiology, Public Health and Preventive Medicine, University of Ottawa, Ottawa, Canada; Department of Family Medicine, University of Ottawa, Ottawa, Canada; C.T. Lamont Primary Health Care Research Centre, Bruyère Research Institute, Ottawa, Canada.
authors.forename: Lise M
authors.initials: LM
authors.lastname: Bjerre
mesh_terms: D014150:Antipsychotic Agents / Q000009:adverse effects*; D006801:Humans; D000069348:Quetiapine Fumarate / Q000627:therapeutic use*; D016032:Randomized Controlled Trials as Topic; D007319:Sleep Initiation and Maintenance Disorders / Q000188:drug therapy*
chemical_list: D014150:Antipsychotic Agents; D000069348:Quetiapine Fumarate
keywords: Antipsychotic agents; Insomnia; Off-label use; Sleep initiation and maintenance disorders