Khazaie Habibolah, Sharafkhaneh Amir, Khazaie Sepideh, Ghadami Mohammad Rasoul
Sleep Disorders Research Center, Kermanshah University of Medical Sciences, Kermanshah, Iran.
Department of Medicine, Section of Pulmonary, Critical Care and Sleep Medicine, Baylor College of Medicine, Houston, TX, USA.
Sleep Breath. 2018 Mar;22(1):109-114. doi: 10.1007/s11325-017-1537-y. Epub 2017 Jul 13.
With increasing use of atypical antipsychotic (AAP) agents, the concern has been raised about the association between AAP agents and medical complications. Obstructive sleep apnea (OSA) is a common breathing disorder that adversely affects health and quality of life. Because the major risk factors for OSA are weight gain and obesity by altering the upper airway anatomy, an association between AAP and development of OSA is predictable. However, we hypothesized that AAP may promote OSA not only by weight gain but also because of its potential effects on upper airway muscle function. In the present study, we evaluated the possible association between AAP use and the severity of OSA.
A sample of patients using AAP for treatment of paradoxical insomnia was evaluated before and at least 8 weeks after AAP use. Patients were divided based on type of AAP use to olanzapine, risperidone, and quetiapine groups. Patients used olanzapine (5-10 mg), risperidone (2-4 mg), or quetiapine (100-200 mg) 2 h before bedtime. Before and after treatment, respiratory variables were recorded using polysomnography. BMI, neck circumference (NC), and waist circumference (WC) were measured before and after treatment period.
There was no significant difference between pre- and post-treatment apnea index (0.2 ± 0.6 vs. 2.6 ± 4.3; p = 0.094) in olanzapine group. However, significant differences in hypopnea index (5.1 ± 5 vs. 30 ± 10.8; p < 0.0001) and AHI (5.3 ± 4.9 vs. 32.6 ± 9.6; p < 0.0001) were observed. Similar results were found in quetiapine and risperidone groups, except that in quetiapine group, apnea index was significantly increased after treatment period (0.7 ± 1.2 in pre-treatment vs. 3.1 ± 2.4 in post-treatment; p = 0.007). There were no significant changes in BMI, NC, and WC during treatment period in all three groups.
While AAP medications are known cause of weight gain as a main risk factor of OSA, our finding demonstrated a weight-independent association between AAP medications and worsening respiration during sleep.
随着非典型抗精神病药物（AAP）使用的增加，人们对AAP药物与医学并发症之间的关联日益关注。阻塞性睡眠呼吸暂停（OSA）是一种常见的呼吸障碍，会对健康和生活质量产生不利影响。由于OSA的主要危险因素是体重增加和肥胖，这会改变上呼吸道解剖结构，因此AAP与OSA的发生之间存在关联是可以预见的。然而，我们推测AAP可能不仅通过体重增加促进OSA，还因其对上呼吸道肌肉功能的潜在影响。在本研究中，我们评估了使用AAP与OSA严重程度之间的可能关联。
对使用AAP治疗反常性失眠的患者样本在使用AAP之前和至少8周后进行评估。根据使用的AAP类型将患者分为奥氮平、利培酮和喹硫平组。患者在睡前2小时服用奥氮平（5 - 10毫克）、利培酮（2 - 4毫克）或喹硫平（100 - 200毫克）。治疗前后，使用多导睡眠图记录呼吸变量。在治疗期前后测量体重指数（BMI）、颈围（NC）和腰围（WC）。
奥氮平组治疗前后的呼吸暂停指数无显著差异（0.2±0.6对2.6±4.3；p = 0.094）。然而，观察到低通气指数（5.1±5对30±10.8；p < 0.0001）和呼吸紊乱指数（AHI）（5.3±4.9对32.6±9.6；p < 0.0001）有显著差异。喹硫平和利培酮组也发现了类似结果，但喹硫平组在治疗期后呼吸暂停指数显著增加（治疗前0.7±1.2对治疗后3.1±2.4；p = 0.007）。在所有三组治疗期间BMI、NC和WC均无显著变化。
虽然AAP药物是已知的导致体重增加的原因，而体重增加是OSA的主要危险因素，但我们的研究结果表明AAP药物与睡眠期间呼吸恶化之间存在与体重无关的关联。
