Antipsychotic medications and sleep problems in patients with schizophrenia

Erik Cederlöf; Minna Holm; Heidi Taipale; Jari Tiihonen; Antti Tanskanen; Markku Lähteenvuo; Kaisla Lahdensuo; Olli Kampman; Asko Wegelius; Erkki Isometsä; Tuula Kieseppä; Aarno Palotie; Jaana Suvisaari; Tiina Paunio; SUPER-Finland study

doi:10.1016/j.schres.2024.03.015

Antipsychotic medications and sleep problems in patients with schizophrenia

Schizophr Res. 2024 Apr 4:267:230-238. doi: 10.1016/j.schres.2024.03.015. Online ahead of print.

Authors

Collaborators

SUPER-Finland study:
Aija Kyttälä², Anders Kämpe¹¹, Annamari Tuulio-Henriksson¹², Ari Ahola-Olli¹¹, Asko Wegelius⁶, Auli Toivola², Benjamin Neale², Huei-Yi Shen¹¹, Imre Västrik¹¹, Jouko Lönnqvist², Juha Veijola¹³, Jussi Niemi-Pynttäri¹⁴, Katja Häkkinen⁵, Kimmo Suokas¹⁵, Mark Daly¹⁶, Noora Ristiluoma², Olli Pietiläinen¹⁷, Risto Kajanne¹¹, Steven E Hyman², Tarjinder Singh², Teemu Männynsalo⁶, Tuomas Jukuri¹⁸, Willehard Haaki¹⁹

Affiliations

¹ Finnish Institute for Health and Welfare, Finland; Department of Psychiatry, University of Helsinki and Helsinki University Hospital, Finland; SleepWell Research Program, Faculty of Medicine, University of Helsinki and Helsinki University Hospital, Finland. Electronic address: erik.cederlof@helsinki.fi.
² Finnish Institute for Health and Welfare, Finland.
³ Karolinska Institutet, Sweden; Niuvanniemi Hospital, University of Eastern Finland, Finland.
⁴ Karolinska Institutet, Sweden.
⁵ Niuvanniemi Hospital, University of Eastern Finland, Finland.
⁶ Department of Psychiatry, University of Helsinki and Helsinki University Hospital, Finland.
⁷ University of Tampere, Faculty of Medicine and Health Technology, Finland; University of Turku, Faculty of Medicine, Finland; The Pirkanmaa Wellbeing Services County, Department of Psychiatry, Tampere, Finland; Umeå University, Department of Clinical Sciences, Psychiatry, Sweden; The Wellbeing Services County of Ostrobothnia, Department of Psychiatry, Finland.
⁸ Finnish Ministry of Social Affairs and Health, Finland.
⁹ Institute for Molecular Medicine, Finland.
¹⁰ Finnish Institute for Health and Welfare, Finland; Department of Psychiatry, University of Helsinki and Helsinki University Hospital, Finland; SleepWell Research Program, Faculty of Medicine, University of Helsinki and Helsinki University Hospital, Finland.
¹¹ Institute for Molecular Medicine Finland, Finland.
¹² Department of Psychology and Logopedics, Faculty of Medicine, University of Helsinki, Finland.
¹³ Department of Psychiatry, Research Unit of Clinical Neuroscience, University of Oulu, Finland; Department of Psychiatry, University Hospital of Oulu, Finland.
¹⁴ Tampere University Hospital, Finland.
¹⁵ Tampere University Hospital, Finland; Department of Psychiatry, Pirkanmaa Hospital District, Finland.
¹⁶ Finnish Institute for Health and Welfare, Finland; Institute for Molecular Medicine Finland, Finland; Massachusetts General Hospital Massachusetts General Hospital, United States of America.
¹⁷ Neuroscience Center, HiLIFE, University of Helsinki, Finland.
¹⁸ Department of Psychiatry, University Hospital of Oulu, Finland.
¹⁹ Turku University Hospital, Turku, Finland.

PMID: 38579432
DOI: 10.1016/j.schres.2024.03.015

Abstract

Background: Sleep problems are common and related to a worse quality of life in patients with schizophrenia. Almost all patients with schizophrenia use antipsychotic medications, which usually increase sleep. Still, the differences in subjective sleep outcomes between different antipsychotic medications are not entirely clear.

Methods: This study assessed 5466 patients with schizophrenia and is part of the nationwide Finnish SUPER study. We examined how the five most common antipsychotic medications (clozapine, olanzapine, quetiapine, aripiprazole, and risperidone) associate with questionnaire-based sleep problems in logistic regression analyses, including head-to-head analyses between different antipsychotic medications. The sleep problems were difficulties initiating sleep, early morning awakenings, fatigue, poor sleep quality, short (≤6 h) and long sleep duration (≥10 h).

Results: The average number of antipsychotic medications was 1.59 per patient. Clozapine was associated with long sleep duration (49.0 % of clozapine users vs 30.2 % of other patients, OR = 2.05, 95 % CI 1.83-2.30, p < .001). Olanzapine and risperidone were in head-to-head analyses associated with less sleep problems than patients using aripiprazole, quetiapine, or no antipsychotic medication. Aripiprazole and quetiapine were associated with more insomnia symptoms and poorer sleep quality. Patients without antipsychotic medications (N = 159) had poorer sleep quality than patients with antipsychotic use, and short sleep duration was common (21.5 % of patients using antipsychotics vs 7.8 % of patients using antipsychotics, OR = 2.97, 95 % CI 1.98-4.44, p < .001).

Conclusions: Prevalence of sleep problems is markedly related to the antipsychotic medication the patient uses. These findings underline the importance of considering and assessing sleep problems when treating schizophrenia patients with antipsychotics.

Keywords: Antipsychotics; Hypersomnia; Insomnia; Schizophrenia; Sleep.