Association between psychotropic medication and sleep microstructure: evidence from large population studies

Simon Hartmann; Liborio Parrino; Kristine Ensrud; Katie L. Stone; Susan Redline; Scott R. Clark; Mathias Baumert

doi:10.5664/jcsm.10394

Association between psychotropic medication and sleep microstructure: evidence from large population studies

Simon Hartmann
, Liborio Parrino
, Kristine Ensrud
, Katie L. Stone
, Susan Redline
, Scott R. Clark
, Mathias Baumert

Epidemiology & Community Health

Research output: Contribution to journal › Article › peer-review

8 Scopus citations

Abstract

Study Objectives: To assess the association between psychotropic medications and sleep microstructure in large community-based cohorts of older people. Methods: We analyzed overnight polysomnograms of 381 women from the Study of Osteoporotic Fractures (SOF) and 2,657 men from the Osteoporotic Fractures in Men Sleep Study (MrOS), who either used no psychotropic medication (n = 2,819), only benzodiazepines (n = 112), or only selective serotonin reuptake inhibitors (SSRI) (n = 107). Sleep microstructure (cyclic alternating pattern, CAP) was compared between the no medication group and psychotropic medication groups using the Mann-Whitney U test. Significant differences were investigated using multivariable linear regression adjusted for confounders. Results: CAP rate, arousal index, apnea-hypopnea index, and the frequency of slow, low-amplitude electroencephalography activation phases were significantly lower in MrOS participants using benzodiazepines than participants not taking psychotropic medication. SSRI users in MrOS experienced no altered sleep microstructure compared to those with no psychotropic use. SOF participants using benzodiazepines did not show similar associations with sleep microstructure. However, SSRI users from SOF had a significantly higher frequency of rapid, high-amplitude electroencephalography activation phases (A2 + 3) and periodic limb-movement index than participants not taking psychotropic medication. Multivariable linear regression adjusted for demographic, lifestyle, mood disorders, and health variables indicated additional significant associations between benzodiazepine usage and CAP rate and A2 + 3 index, respectively, in older men, and between CAP rate and SSRI usage in older women. Conclusions: We identified significant associations between sleep microstructure and psychotropic drugs in MrOS and SOF, highlighting the importance of comprehensive sleep analysis, including CAP. Our results may improve understanding of the differences in sleep-wake mechanisms based on psychotropic usage.

Original language	English (US)
Pages (from-to)	581-589
Number of pages	9
Journal	Journal of Clinical Sleep Medicine
Volume	19
Issue number	3
DOIs	https://doi.org/10.5664/jcsm.10394
State	Published - Jul 1 2023

Bibliographical note

Funding Information:
All authors have seen and approved this manuscript. Work for this study was performed at the University of Adelaide. The National Sleep Research Resource is supported by grant number HL114473 from the National Heart, Lung, and Blood Institute (NHLBI), National Institutes of Health. The NHLBI provides funding for the Osteoporotic Fractures in Men (MrOS) ancillary sleep study Outcomes of Sleep Disorders in Older Men under the following grant numbers: R01 HL071194, R01 HL070848, R01 HL070847, R01 HL070842, R01 HL070841, R01 HL070837, R01 HL070838, and R01 HL070839. The National Institutes of Health funding supported the Study of Osteoporotic Fractures (SOF). The National Institute on Aging provides support under the following grant numbers: R01 AG005407, R01 AR35582, R01 AR35583, R01 AR35584, R01 AG005394, R01 AG027574, R01 AG027576, and R01 AG026720. The authors report no conflicts of interest.

Publisher Copyright:
© 2023 American Academy of Sleep Medicine. All rights reserved.

Keywords

benzodiazepines
cyclic alternating pattern
selective serotonin reuptake inhibitors
sleep studies
sleep-wake mechanisms

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10.5664/jcsm.10394

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title = "Association between psychotropic medication and sleep microstructure: evidence from large population studies",

abstract = "Study Objectives: To assess the association between psychotropic medications and sleep microstructure in large community-based cohorts of older people. Methods: We analyzed overnight polysomnograms of 381 women from the Study of Osteoporotic Fractures (SOF) and 2,657 men from the Osteoporotic Fractures in Men Sleep Study (MrOS), who either used no psychotropic medication (n = 2,819), only benzodiazepines (n = 112), or only selective serotonin reuptake inhibitors (SSRI) (n = 107). Sleep microstructure (cyclic alternating pattern, CAP) was compared between the no medication group and psychotropic medication groups using the Mann-Whitney U test. Significant differences were investigated using multivariable linear regression adjusted for confounders. Results: CAP rate, arousal index, apnea-hypopnea index, and the frequency of slow, low-amplitude electroencephalography activation phases were significantly lower in MrOS participants using benzodiazepines than participants not taking psychotropic medication. SSRI users in MrOS experienced no altered sleep microstructure compared to those with no psychotropic use. SOF participants using benzodiazepines did not show similar associations with sleep microstructure. However, SSRI users from SOF had a significantly higher frequency of rapid, high-amplitude electroencephalography activation phases (A2 + 3) and periodic limb-movement index than participants not taking psychotropic medication. Multivariable linear regression adjusted for demographic, lifestyle, mood disorders, and health variables indicated additional significant associations between benzodiazepine usage and CAP rate and A2 + 3 index, respectively, in older men, and between CAP rate and SSRI usage in older women. Conclusions: We identified significant associations between sleep microstructure and psychotropic drugs in MrOS and SOF, highlighting the importance of comprehensive sleep analysis, including CAP. Our results may improve understanding of the differences in sleep-wake mechanisms based on psychotropic usage.",

keywords = "benzodiazepines, cyclic alternating pattern, selective serotonin reuptake inhibitors, sleep studies, sleep-wake mechanisms",

author = "Simon Hartmann and Liborio Parrino and Kristine Ensrud and Stone, \{Katie L.\} and Susan Redline and Clark, \{Scott R.\} and Mathias Baumert",

note = "Funding Information: All authors have seen and approved this manuscript. Work for this study was performed at the University of Adelaide. The National Sleep Research Resource is supported by grant number HL114473 from the National Heart, Lung, and Blood Institute (NHLBI), National Institutes of Health. The NHLBI provides funding for the Osteoporotic Fractures in Men (MrOS) ancillary sleep study Outcomes of Sleep Disorders in Older Men under the following grant numbers: R01 HL071194, R01 HL070848, R01 HL070847, R01 HL070842, R01 HL070841, R01 HL070837, R01 HL070838, and R01 HL070839. The National Institutes of Health funding supported the Study of Osteoporotic Fractures (SOF). The National Institute on Aging provides support under the following grant numbers: R01 AG005407, R01 AR35582, R01 AR35583, R01 AR35584, R01 AG005394, R01 AG027574, R01 AG027576, and R01 AG026720. The authors report no conflicts of interest. Publisher Copyright: {\textcopyright} 2023 American Academy of Sleep Medicine. All rights reserved.",

year = "2023",

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doi = "10.5664/jcsm.10394",

language = "English (US)",

volume = "19",

pages = "581--589",

journal = "Journal of Clinical Sleep Medicine",

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}

TY - JOUR

T1 - Association between psychotropic medication and sleep microstructure

T2 - evidence from large population studies

AU - Hartmann, Simon

AU - Parrino, Liborio

AU - Ensrud, Kristine

AU - Stone, Katie L.

AU - Redline, Susan

AU - Clark, Scott R.

AU - Baumert, Mathias

N1 - Funding Information: All authors have seen and approved this manuscript. Work for this study was performed at the University of Adelaide. The National Sleep Research Resource is supported by grant number HL114473 from the National Heart, Lung, and Blood Institute (NHLBI), National Institutes of Health. The NHLBI provides funding for the Osteoporotic Fractures in Men (MrOS) ancillary sleep study Outcomes of Sleep Disorders in Older Men under the following grant numbers: R01 HL071194, R01 HL070848, R01 HL070847, R01 HL070842, R01 HL070841, R01 HL070837, R01 HL070838, and R01 HL070839. The National Institutes of Health funding supported the Study of Osteoporotic Fractures (SOF). The National Institute on Aging provides support under the following grant numbers: R01 AG005407, R01 AR35582, R01 AR35583, R01 AR35584, R01 AG005394, R01 AG027574, R01 AG027576, and R01 AG026720. The authors report no conflicts of interest. Publisher Copyright: © 2023 American Academy of Sleep Medicine. All rights reserved.

PY - 2023/7/1

Y1 - 2023/7/1

N2 - Study Objectives: To assess the association between psychotropic medications and sleep microstructure in large community-based cohorts of older people. Methods: We analyzed overnight polysomnograms of 381 women from the Study of Osteoporotic Fractures (SOF) and 2,657 men from the Osteoporotic Fractures in Men Sleep Study (MrOS), who either used no psychotropic medication (n = 2,819), only benzodiazepines (n = 112), or only selective serotonin reuptake inhibitors (SSRI) (n = 107). Sleep microstructure (cyclic alternating pattern, CAP) was compared between the no medication group and psychotropic medication groups using the Mann-Whitney U test. Significant differences were investigated using multivariable linear regression adjusted for confounders. Results: CAP rate, arousal index, apnea-hypopnea index, and the frequency of slow, low-amplitude electroencephalography activation phases were significantly lower in MrOS participants using benzodiazepines than participants not taking psychotropic medication. SSRI users in MrOS experienced no altered sleep microstructure compared to those with no psychotropic use. SOF participants using benzodiazepines did not show similar associations with sleep microstructure. However, SSRI users from SOF had a significantly higher frequency of rapid, high-amplitude electroencephalography activation phases (A2 + 3) and periodic limb-movement index than participants not taking psychotropic medication. Multivariable linear regression adjusted for demographic, lifestyle, mood disorders, and health variables indicated additional significant associations between benzodiazepine usage and CAP rate and A2 + 3 index, respectively, in older men, and between CAP rate and SSRI usage in older women. Conclusions: We identified significant associations between sleep microstructure and psychotropic drugs in MrOS and SOF, highlighting the importance of comprehensive sleep analysis, including CAP. Our results may improve understanding of the differences in sleep-wake mechanisms based on psychotropic usage.

AB - Study Objectives: To assess the association between psychotropic medications and sleep microstructure in large community-based cohorts of older people. Methods: We analyzed overnight polysomnograms of 381 women from the Study of Osteoporotic Fractures (SOF) and 2,657 men from the Osteoporotic Fractures in Men Sleep Study (MrOS), who either used no psychotropic medication (n = 2,819), only benzodiazepines (n = 112), or only selective serotonin reuptake inhibitors (SSRI) (n = 107). Sleep microstructure (cyclic alternating pattern, CAP) was compared between the no medication group and psychotropic medication groups using the Mann-Whitney U test. Significant differences were investigated using multivariable linear regression adjusted for confounders. Results: CAP rate, arousal index, apnea-hypopnea index, and the frequency of slow, low-amplitude electroencephalography activation phases were significantly lower in MrOS participants using benzodiazepines than participants not taking psychotropic medication. SSRI users in MrOS experienced no altered sleep microstructure compared to those with no psychotropic use. SOF participants using benzodiazepines did not show similar associations with sleep microstructure. However, SSRI users from SOF had a significantly higher frequency of rapid, high-amplitude electroencephalography activation phases (A2 + 3) and periodic limb-movement index than participants not taking psychotropic medication. Multivariable linear regression adjusted for demographic, lifestyle, mood disorders, and health variables indicated additional significant associations between benzodiazepine usage and CAP rate and A2 + 3 index, respectively, in older men, and between CAP rate and SSRI usage in older women. Conclusions: We identified significant associations between sleep microstructure and psychotropic drugs in MrOS and SOF, highlighting the importance of comprehensive sleep analysis, including CAP. Our results may improve understanding of the differences in sleep-wake mechanisms based on psychotropic usage.

KW - benzodiazepines

KW - cyclic alternating pattern

KW - selective serotonin reuptake inhibitors

KW - sleep studies

KW - sleep-wake mechanisms

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UR - https://www.scopus.com/pages/publications/85149183637#tab=citedBy

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JO - Journal of Clinical Sleep Medicine

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ER -

Association between psychotropic medication and sleep microstructure: evidence from large population studies

Abstract

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