Quetiapine, an antipsychotic medication approved for schizophrenia and bipolar disorder, is commonly prescribed off-label at low doses to treat insomnia. However, new research raises concerns about using it in patients with obstructive sleep apnea (OSA), suggesting it may negatively impact their alertness and performance.
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A study conducted by Cricket Fauska, a sleep researcher at Flinders University in Australia, involved 15 participants with OSA who had trouble maintaining sleep. Each took quetiapine one night and a placebo the next, revealing that although sleep quality appeared improved, performance on psychomotor vigilance tests significantly declined. Reaction times were longer after taking quetiapine, with the median number of attention lapses increasing from 2 (placebo) to 10 (quetiapine). Additionally, simulated accidents nearly doubled, although researchers cautioned about interpreting this finding due to the small sample size.
Obstructive sleep apnea, which affects nearly one billion people worldwide, is often overlooked by those suffering from it. Symptoms include loud snoring, morning headaches, and daytime fatigue, yet it's estimated that 80% of people with the condition are unaware of their diagnosis. This lack of awareness poses risks when sedative medications like quetiapine are used, as they may mask the impairment in alertness and reflexes.
The study's findings indicate that some participants did not feel particularly sleepy despite experiencing measurable declines in performance, raising safety concerns, especially for activities such as driving. Researcher Danny Eckert advises against using quetiapine as a routine treatment for sleep issues in those with or at risk for sleep apnea.
While off-label prescribing is standard when benefits outweigh risks, the study highlights the need for caution in recommending quetiapine for sleep problems, particularly in individuals predisposed to OSA. The authors call for larger trials with varied dosages and longer durations to better understand the risks of repetitive use. They also emphasize individualized care rather than a blanket use of sedatives.
As a reminder, quetiapine is a prescription medication, and changes to its use should only be made under medical supervision. Concerns regarding sleep issues or suspected sleep apnea should be discussed with a healthcare professional.