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. 2024 May:267:230-238.
doi: 10.1016/j.schres.2024.03.015. Epub 2024 Apr 4.

Antipsychotic medications and sleep problems in patients with schizophrenia

Erik Cederlöf  1 , Minna Holm  2 , Heidi Taipale  3 , Jari Tiihonen  4 , Antti Tanskanen  4 , Markku Lähteenvuo  5 , Kaisla Lahdensuo  6 , Olli Kampman  7 , Asko Wegelius  6 , Erkki Isometsä  6 , Tuula Kieseppä  8 , Aarno Palotie  9 , Jaana Suvisaari  2 , Tiina Paunio  10 ; SUPER-Finland study
Collaborators, Affiliations
Free article

Antipsychotic medications and sleep problems in patients with schizophrenia

Erik Cederlöf et al. Schizophr Res. 2024 May.
Free article

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 not 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.

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Conflict of interest statement

Declaration of competing interest Regarding conflicts of interest, Markku Lähteenvuo is an owner and board member of Genomi Solutions Ltd. and Nursie Health Ltd. and has received honoraria from Sunovion, Orion Pharma, Janssen-Cilag, Otsuka Pharma, Lundbeck, and Medscape, travel funds from Sunovion, and research grants from the Finnish Medical Foundation, the Emil Aaltonen Foundation, and the Finnish Cultural Foundation. Jari Tiihonen has participated in research projects funded by grants from Janssen-Cilag and Eli Lilly to their employing institution; has received personal fees from the Finnish Medicines Agency (Fimea), European Medicines Agency (EMA), Eli Lilly, Janssen-Cilag, Lundbeck, and Otsuka; is a member of the advisory board for Lundbeck; and has received grants from the Stanley Foundation and the Sigrid Jusélius Foundation. None of the other authors report any financial relationships with commercial interests.

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