Antipsychotic Medication’s Dual Effect on Sleep Apnea and Driving Skills

A recent study found that a commonly used antipsychotic medicine, quetiapine, can reduce obstructive sleep apnea (OSA) but may impair driving ability the next day. This research came from Flinders University in Adelaide, Australia, and was published in the Annals of the American Thoracic Society.

The study involved 15 adults with OSA, all facing challenges maintaining sleep. Over two nights, each participant experienced separate sleep studies. On one night, they took 50mg of quetiapine before sleep. On the other, they had a placebo.

Quetiapine is frequently prescribed for conditions like schizophrenia, bipolar disorder, and depression. It is also used off-label to address insomnia, anxiety, and sleep issues.

Researchers monitored participants’ breathing, brain activity, oxygen levels, and leg movements during the study.

Participants taking quetiapine slept over 40 minutes longer and experienced 45% less wakefulness. Their apnea-related events decreased from 27 to 20 per hour. Despite these benefits, quetiapine affected driving performance, evidenced by slower reaction times and more attention lapses on a driving simulator test conducted 30 minutes after waking.

Most participants reported feeling sleepier after taking quetiapine. Moreover, one in four did not recognize their impairment level, raising concerns that they might drive or operate machinery unwittingly impaired.

Other side effects included nausea, restless legs, and sudden blood pressure drops, which affected about one in three people.

The study’s small sample size and short duration are notable limitations. Researchers highlighted the need for larger, long-term studies to explore quetiapine’s suitability for treating sleep apnea and insomnia.

Pending further research, experts advise avoiding driving or safety-critical tasks for at least 9.5 hours post-quetiapine intake. Differences in drug metabolism between sexes, with women metabolizing these drugs more slowly, might impact efficacy and risk of side effects.

Ashley Curtis, Ph.D., highlighted that future studies need to examine whether newer medications demonstrate similar sex-specific patterns for safe and effective dosing. Curtis emphasized the need for understanding the trade-offs between sleep benefits and cognitive effects, especially in older adults.

Cognitive behavioral therapy for insomnia remains a pivotal part of long-term management, despite the potential short-term efficacy of medications. Chelsie Rohrscheib advises patients on quetiapine for sleep, especially those with sleep apnea or morning grogginess, to consult their doctors about the balance between benefits and risks.