Oral Papers: Medical Specialties II: Pulmonology, Infectious Disease
A significant proportion of 20% to 48% of patients with schizophrenia is known to have sleep-disordered breathing (SDB) or obstructive sleep apnea (OSA)1, depending on the study setting. Insomnia is associated with severe psychopathology, poor quality of life and increased suicidality in schizophrenia. Both typical and atypical antipsychotics are known to improve the overall sleep architecture in schizophrenia. On the other hand, antipsychotics are also associated with worsening of pre-existing OSA and or increasing the risk of OSA in this population, through weight gain and weight-independent mechanism. The association between antipsychotic medications and OSA among schizophrenia patients has been explored in a small number of studies, often without a rigorous design. Screening for OSA is not done routinely in psychiatric practice even when symptoms of insomnia and or excessive daytime sleepiness are reported. We intend to review the available data, inform a better clinical practice and propose a direction for future research.
In a systematic review, we searched with the terms “obstructive sleep,” “apnea,” “hypopnea,” “schizophrenia,” “antipsychotic,” “atypical,” and “sleep-disordered breathing” on MeSH to pull up all available reports, from 1998 until 2018. Out of more than 500 entries, we reviewed the abstracts following the PRISMA guideline and identified the systematic studies that included subjects with schizophrenia on antipsychotic medications, and used a standardized diagnostic tool for OSA. Only observational study designs were included. Five studies fulfilled the inclusion criteria. One of the studies used a prospective approach, and all others used cross-sectional or chart review method.
Two of these studies2, 3 found a significant association between antipsychotics and OSA, independent of body-mass-index (BMI). One study found a significant difference in the hypopnea index in the olanzapine and quetiapine groups. One study found obesity, male gender and chronic antipsychotic use as the risk factors for OSA. One study found a significant association between the doses of antipsychotics and increased risk of OSA, independent of BMI.
Antipsychotic medications may increase the risk of OSA and may also worsen pre-existing OSA. Overweight patients with schizophrenia on chronic antipsychotic medications are at particularly high risk and should be evaluated formally for OSA when symptoms are present. Body-mass-index might be a partially independent variable in this association. Rigorous study design, comparing different classes and doses of antipsychotic medications are needed to develop a practice guideline. In this interactive session, participants will be able to use small group discussion and mobile-based real-time voting for pre and post-session questions.
1. Water et al. Sleep-disordered breathing in schizophrenia: an audit.
2. Shirani et al. The impact of atypical antipsychotic use on obstructive sleep apnea: a pilot study and literature review.
3. Rishi et al. Atypical antipsychotic medications are independently associated with severe obstructive sleep apnea.