Quetiapine improves sleep in obstructive sleep apnea but impairs next-day driving performance, small trial finds
核心洞察
A randomized controlled trial of 15 adults with obstructive sleep apnea (搜索) found that 50 mg of quetiapine increased total sleep time by more than 40 minutes and reduced wakefulness by 45%.
Despite improved sleep, quetiapine more than tripled attention lapses and slowed reaction times in driving simulator tests the next morning.
Roughly one in four participants did not recognize their own impairment, raising safety concerns for driving and operating machinery.
Quetiapine, a widely prescribed antipsychotic often used off-label at low doses for insomnia (搜索), may improve sleep in people with obstructive sleep apnea (搜索) (OSA) while simultaneously impairing their ability to drive safely the next morning, according to a small randomized controlled trial published in the Annals of the American Thoracic Society.
Researchers from Flinders University in Adelaide, Australia, conducted the study in 15 adults with OSA who also had difficulty maintaining sleep. Each participant underwent two overnight sleep studies approximately one week apart, taking 50 mg of quetiapine (Seroquel) before bed one night and a placebo the other night. The researchers monitored participants throughout the night, tracking breathing, brain activity, oxygen levels, and leg movements.
Sleep Improves, but Performance Declines
The drug produced measurable improvements in sleep. Participants who took quetiapine experienced more than 40 minutes of additional total sleep time and 45% less wakefulness during the night. Their apnea-related events also decreased from 27 to 20 events per hour.
However, these gains came at a cost to next-day functioning. Psychomotor vigilance test results showed longer reaction times compared to placebo, and the number of attention lapses during the task increased from a median of 2 on placebo to 10 with quetiapine. In a driving simulator test administered within 30 minutes of waking, those taking quetiapine experienced more than triple the number of attention lapses and swerved out of their lane more often. The number of simulated accidents nearly doubled, though researchers urged caution interpreting this particular result given the small sample size.
A Dangerous Disconnect Between Feeling and Function
The most concerning finding, according to lead author Cricket Fauska, a sleep researcher at Flinders University, was the disconnect between how participants felt and how they actually performed. Eleven out of 15 participants reported feeling sleepier the morning after taking the medication, but roughly one in four people did not recognize their level of impairment. Some participants did not feel especially sleepy despite clear and measurable declines in performance.
"This disconnect between how people feel and how they're actually functioning is a safety risk in itself, especially when driving," Fauska noted.
Other mild to moderate side effects included nausea, restless legs, and a sudden blood pressure drop upon standing, which affected one in three people taking quetiapine.
Implications for Off-Label Prescribing
Sleep researcher Danny Eckert emphasized that quetiapine should not be used as a routine sleep treatment for people who have or might have sleep apnea, especially when alertness the next day really matters. He also underscored a broader principle: sleep apnea results from different mechanisms depending on the person, and the best approach is individualized care rather than defaulting to sedative medications across the board.
The findings carry particular weight given the scale of undiagnosed sleep apnea. Worldwide, nearly one billion people may be affected by the condition, and about 80% of people with sleep apnea are believed to be unaware of their diagnosis. This means a significant number of patients might be taking a drug that makes their sleep feel better without knowing it actually impairs their alertness and reflexes the next day.
Study Limitations and Recommendations
The authors acknowledged important limitations. The sample involved only 15 people, and each participant took quetiapine or placebo for a single night, so nothing can yet be concluded about the effects of repeated use. The laboratory setting may also not reflect real-world use. The authors advocate for trials in larger groups, with different doses and longer durations, as well as stricter controls on how the drug is prescribed for sleep problems.
Pending follow-up studies, the researchers recommend that people avoid driving or other safety-critical tasks for at least 9.5 hours after taking quetiapine.
Ashley Curtis, PhD, director of the Cognition, Aging, Sleep and Health (CASH) Lab at the University of South Florida, who was not involved in the study, noted that certain hypnotic medications exhibit sex differences in metabolism. Women generally metabolize these drugs more slowly than men, which can influence both efficacy and the risk of next-day side effects. "Future studies should carefully examine whether these newer agents demonstrate similar sex-specific patterns to ensure optimal dosing and safety recommendations," she said.
Curtis also highlighted that the impact of quetiapine on next-day cognitive function warrants further investigation, particularly among older adults, who are already vulnerable to cognitive and related side effects related to polypharmacy. She added that insomnia (搜索) is often the result of learned behavioral and cognitive factors that persist over time, and that behavioral interventions such as cognitive behavioral therapy for insomnia remain an important component of long-term management.
Chelsie Rohrscheib, head sleep expert at Wesper, a sleep analysis company in New York, who was not affiliated with the research, advised that patients should not be alarmed by these findings, but that those taking quetiapine for sleep—especially if they have sleep apnea or wake up feeling groggy—should talk with their doctor about whether the benefits outweigh the risks and whether other treatment options might be appropriate.