Antipsychotic Medication and Its Effects on Sleep Apnea and Driving

A study found that a commonly used antipsychotic medication, quetiapine, could reduce obstructive sleep apnea (OSA). However, it also resulted in impaired driving the following morning. The research appeared in the Annals of the American Thoracic Society and involved a small randomized controlled trial conducted by researchers from Flinders University in Adelaide, Australia.

Study Details

The study included 15 adults with OSA who had difficulty maintaining sleep. Each participant underwent two sleep studies about a week apart. On one study night, they ingested 50 mg of quetiapine, known by the brand name Seroquel. This medication is prescribed for schizophrenia, bipolar disorder, and depression, and often used off-label for insomnia and anxiety. On another night, they received a placebo.

Researchers monitored breathing, brain activity, oxygen levels, and leg movements. Participants experienced over 40 minutes more total sleep time and 45% less wakefulness. Apnea-related events fell from 27 to 20 per hour.

Impact on Driving and Side Effects

Despite improved sleep, quetiapine slowed reaction time in a driving simulator test and a 10-minute reaction time test performed shortly after waking. Those on quetiapine had more than three times the attention lapses and swerved more frequently in the simulator.

Eleven out of 15 participants felt sleepier the next morning. A quarter didn’t realize their impairment level, raising concerns about vehicle or machinery operation. Side effects included nausea, restless legs, and blood pressure drops upon standing, affecting one in three users.

Study Limitations and Recommendations

The study had limitations due to its small sample size and single-night evaluation in a lab setting, limiting its real-world applicability. Further long-term studies are essential before prescribing quetiapine for sleep apnea and insomnia. Pending these studies, researchers advise avoiding driving or safety-critical tasks for at least 9.5 hours after taking the medication. Women metabolize the drug slower, affecting efficacy and side effects.

Expert Insights

Ashley Curtis, PhD, from the University of South Florida, emphasized understanding sex differences in drug metabolism to ensure proper dosing and safety. She highlighted a need for further research into the medication’s impact on cognitive function, especially among older adults, due to polypharmacy risks.

Chelsie Rohrscheib, a sleep expert at Wesper, agreed with the need to evaluate whether quetiapine’s benefits outweigh its risks for patients, especially those with sleep apnea. She recommended discussing treatment options with a healthcare provider.