Quetiapine is medication used to treat schizophrenia and bipolar disorder. Increasingly, low doses of quetiapine are prescribed "off-label" for insomnia. Quetiapine increases sleep duration with fewer interruptions, and people report feeling more rested. This accounts for why it is popular to prescribe for insomnia. Insomnia and obstructive sleep apnea (OSA) share many symptoms and differential diagnosis can be difficult. While quetiapine may improve sleep and breathing in certain people (i.e in light sleepers) an initial study indicated that quetiapine caused breathing disturbances in healthy individuals. Effects in OSA are unknown. In this placebo-controlled double blind study, participants with mild-moderate OSA will spend 2 nights in the sleep lab, one with quetiapine at a dose commonly prescribed for insomnia and one with placebo. The investigators will assess participants sleep by standard clinical sleep study, and morning alertness using questionnaires, reaction tests, and a driving simulator test.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
OTHER
Masking
QUADRUPLE
Enrollment
15
A single dose of 50mg of quetiapine taken at bedtime for one night.
A placebo sugar pill that looks like the quetiapine tablet taken at bedtime for one night.
Adelaide Institute for Sleep Health
Adelaide, South Australia, Australia
Change in OSA severity (Quetiapine night vs. placebo night)
OSA severity as measured by the AHI (apnoea hypopnea index measured as # events/h sleep) during overnight in-laboratory polysomnography.
Time frame: Two non-consecutive single night sleep studies (Quetiapine night vs. placebo night) up to one month apart.
Change in nadir overnight hypoxemia (Quetiapine night vs. placebo night)
Nadir overnight oxygen saturation during sleep (%) measured via pulse oximetry during overnight in-laboratory polysomnography.
Time frame: Two non-consecutive single night sleep studies (Quetiapine night vs. placebo night) up to one month apart.
Change in mean overnight hypoxemia (Quetiapine night vs. placebo night)
Mean overnight oxygen saturation during sleep (%) measured via pulse oximetry during overnight in-laboratory polysomnography.
Time frame: Two non-consecutive single night sleep studies (Quetiapine night vs. placebo night) up to one month apart.
Change in time below 90% blood arterial oxygen saturation (Quetiapine night vs. placebo night)
Percent time asleep spent below an arterial oxygen saturation of 90% measured via pulse oximetry during overnight in-laboratory polysomnography.
Time frame: Two non-consecutive single night sleep studies (Quetiapine night vs. placebo night) up to one month apart.
Change in sleep efficiency (Quetiapine night vs. placebo night)
Percent time spent asleep divided by the recording time from lights out to lights on during overnight in-laboratory polysomnography.
Time frame: Two non-consecutive single night sleep studies (Quetiapine night vs. placebo night) up to one month apart.
Change in arousal index (Quetiapine night vs. placebo night)
Number of cortical arousals per hour of sleep during overnight in-laboratory polysomnography.
Time frame: Two non-consecutive single night sleep studies (Quetiapine night vs. placebo night) up to one month apart.
Change in sleep architecture (Quetiapine night vs. placebo night)
Proportion of sleep stages (% total sleep time) during overnight in-laboratory polysomnography.
Time frame: Two non-consecutive single night sleep studies (Quetiapine night vs. placebo night) up to one month apart.
Change in respiratory control (Quetiapine night vs. placebo night)
Loop gain and the ventilatory response to arousal (% eupnea) during overnight in-laboratory polysomnography.
Time frame: Two non-consecutive single night sleep studies (Quetiapine night vs. placebo night) up to one month apart.
Change in the respiratory arousal threshold (Quetiapine night vs. placebo night)
Threshold to arousal (% eupnea) during overnight in-laboratory polysomnography.
Time frame: Two non-consecutive single night sleep studies (Quetiapine night vs. placebo night) up to one month apart.
Change in airway collapsibility (Quetiapine night vs. placebo night)
Vpassive (% eupnea) during overnight in-laboratory polysomnography.
Time frame: Two non-consecutive single night sleep studies (Quetiapine night vs. placebo night) up to one month apart.
Change in pharyngeal muscle response (Quetiapine night vs. placebo night)
Vcompensation (% eupnea) during overnight in-laboratory polysomnography.
Time frame: Two non-consecutive single night sleep studies (Quetiapine night vs. placebo night) up to one month apart.
Baseline OSA endotypes (outcomes 8-11) and whether they are associated with changes in OSA severity (Quetiapine night vs. placebo night)
Exploratory analysis to determine if baseline OSA endotypes (outcomes 8-11) are associated with changes in OSA severity (Quetiapine night vs. placebo night)
Time frame: Baseline sleep study
Change in perceived sleepiness (Quetiapine night vs. placebo night)
Next day perceived sleepiness assessed via the Karolinska Sleepiness Scale (10 point scale where 1=extremely alert and 10=extremely sleepy)
Time frame: Next morning following two non-consecutive single night sleep studies (Quetiapine night vs. placebo night) up to one month apart.
Change in driving simulator performance (Quetiapine night vs. placebo night)
Next day alertness as measured via the AusEd driving simulator performance task
Time frame: Next morning following two non-consecutive single night sleep studies (Quetiapine night vs. placebo night) up to one month apart.
Change in psycho-motor vigilance (Quetiapine night vs. placebo night)
Next day alertness as measured via the pschomotor vigilance test (PVT)
Time frame: Next morning following two non-consecutive single night sleep studies (Quetiapine night vs. placebo night) up to one month apart.
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