A medication commonly given as an off-label treatment for sleep problems may be more risky than we thought – and when prescribed for obstructive sleep apnea (OSA) or insomnia, as it often is, it isn’t backed with the science data needed for safe and informed use.
A world-first clinical trial led by Flinders University researchers in Australia has uncovered how quetiapine – or what might be best known as Seroquel – can impede reaction speed and performance, as well as breathing ability, the following day, And individuals may not even realize they’re still affected by the drug.
Quetiapine, an anti-psychotic, is regulated for the treatment of mental health conditions including schizophrenia and bipolar disorder, but in low dose it’s often prescribed for sleep disorders.
“There’s a growing belief that low‑dose quetiapine is a relatively harmless way to help people sleep,” says lead author, Cricket Fauska, a PhD candidate for FHMRI Sleep Health at Flinders University. “Our results show it’s not that simple.
“Although participants slept longer and woke less overnight, their reaction times were slower, and their simulated driving performance was noticeably worse the next morning,” the researcher adds.
One reason its off-label use is becoming more common is an increasing shift away from benzodiazepines and barbiturates, which are more addictive and can be challenging to discontinue.
I didn’t know what quetapine was when I read this study, but I have certainly been prescribed Seroquel before, for use on long-haul flights. Although not recently, at the time it was a doctor I didn’t regularly see, so the drug was considered less “problematic” than benzodiazepine.
But a less addictive alternative doesn’t necessarily make it safer – and, right now, how quetiapine works when primarily prescribed for sleep apnea and insomnia, isn’t well understood.
While it’s worth noting the Flinders University trial was small, the findings pave the way for broader, larger studies to assess the safety of quetapine use for sleep problems.
In the randomised, double‑blind, placebo‑controlled trial, 15 adults spent two nights in a sleep lab. Each person took 50 mg of quetiapine one night, and a placebo the other evening. Scientists gathered detailed sleep data and then monitored participants the following morning, when they completed tests including using a driving simulator, to measure mental alertness.
Quetiapine did indeed improve sleep quality – it reduced breathing interruptions and waking during the night. But the real concern was the data gathered the morning after.
It appeared to impact reaction times, and reduce attention span and steering control – which is a significant risk for people driving cars to work the following morning, despite the more restful night’s sleep.
“What was particularly concerning is that some people didn’t feel especially sleepy the next day, despite performing worse on objective tests,” says Fauska. “That mismatch between how people feel and how they actually function poses a serious safety risk, especially when it comes to driving.”
While an estimated 20% of the US adult population suffer from OSA, somewhere between 80% and 90% don’t know they have the condition.
“And to add to this, a key symptom is finding it difficult to stay asleep,” says senior author Professor Danny Eckert. “Sleep complaints like this are common in general practice, and in Australia around 90 per cent of people who present with insomnia symptoms will leave with a sleeping pill rather than a sleep assessment.
“Our study shows that while quetiapine can make sleep look better on the surface, it may actually make people less safe the next day,” he adds.
More than 75% of the participants in the trial displayed meaningful side effects the morning after a single dose of quetiapine, including noticeable impacts like grogginess, dizzy spells and blood-pressure dips. One person even needed a medical assessment after they experienced a fall.
“Our findings suggest quetiapine should not be used as a routine sleep medication in people with known or possible sleep apnea, particularly when next‑day alertness is critical,” says Eckert.
It also highlights the need for better OSA diagnosis and treatment, as sedatives may indeed reduce sleep disturbances, only to present other health risks in morning.
“Sleep apnea is a complex condition with different underlying drivers in different people,” says Eckert. “What we’re learning is that treatment needs to be tailored – using the right approach, or combination of approaches, for the individual rather than defaulting to sedating medications.”
The research was published in the journal Annals of the American Thoracic Society.
Source: Flinders University
