Insomnia disorders are associated with increased cardiometabolic disturbances and death risks from cardiovascular diseases in psychiatric patients treated with weight-gain-inducing psychotropic drugs: results from a Swiss cohort

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Abstract

Study objectives

Insomnia disorders as well as cardiometabolic disorders are highly prevalent in the psychiatric population compared to the general population. We aimed to investigate their association and evolution over time in a Swiss psychiatric cohort.

Methods

Data for 2861 patients (8954 observations) were obtained from two prospective cohorts (PsyMetab and PsyClin) with metabolic parameters monitored routinely during psychotropic treatment. Insomnia disorders were based on the presence of ICD-10 “F51.0" diagnosis (non-organic insomnia), the prescription of sedatives before bedtime or the discharge letter. Metabolic syndrome was defined using the International Diabetes Federation definition, while the 10-year risk of cardiovascular event or death was assessed using the Framingham Risk Score and the Systematic Coronary Risk Estimation, respectively.

Results

Insomnia disorders were observed in 30% of the cohort, who were older, predominantly female, used more psychotropic drugs carrying risk of high weight gain (olanzapine, clozapine, valproate) and were more prone to suffer from schizoaffective or bipolar disorders. Multivariate analyses showed that patients with high body mass index (OR = 2.02, 95%CI [1.51–2.72] for each ten-kg/m ² increase), central obesity (OR = 2.20, [1.63–2.96]), hypertension (OR = 1.86, [1.23–2.81]), hyperglycemia (OR = 3.70, [2.16–6.33]), high density lipoprotein hypocholesterolemia in women (OR = 1.51, [1.17–1.95]), metabolic syndrome (OR = 1.84, [1.16–2.92]) and higher 10-year risk of death from cardiovascular diseases (OR = 1.34, [1.17–1.53]) were more likely to have insomnia disorders. Time and insomnia disorders were associated with a deterioration of cardiometabolic parameters.

Conclusions

Insomnia disorders are significantly associated with metabolic worsening and risk of death from cardiovascular diseases in psychiatric patients.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12888-022-03983-3.

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Most cited references 24

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International classification of sleep disorders-third edition: highlights and modifications.

Michael J Sateia (2014)

The recently released third edition of the International Classification of Sleep Disorders (ICSD) is a fully revised version of the American Academy of Sleep Medicine's manual of sleep disorders nosology, published in cooperation with international sleep societies. It is the key reference work for the diagnosis of sleep disorders. The ICSD-3 is built on the same basic outline as the ICSD-2, identifying seven major categories that include insomnia disorders, sleep-related breathing disorders, central disorders of hypersomnolence, circadian rhythm sleep-wake disorders, sleep-related movement disorders, parasomnias, and other sleep disorders. Significant modifications have been made to the nosology of insomnia, narcolepsy, and parasomnias. Major features and changes of the manual are reviewed in this article. The rationales for these changes are also discussed.

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Comparative efficacy and tolerability of 32 oral antipsychotics for the acute treatment of adults with multi-episode schizophrenia: a systematic review and network meta-analysis

Maximilian Huhn, Adriani Nikolakopoulou, Johannes Schneider-Thoma … (2019)

Summary Background Schizophrenia is one of the most common, burdensome, and costly psychiatric disorders in adults worldwide. Antipsychotic drugs are its treatment of choice, but there is controversy about which agent should be used. We aimed to compare and rank antipsychotics by quantifying information from randomised controlled trials. Methods We did a network meta-analysis of placebo-controlled and head-to-head randomised controlled trials and compared 32 antipsychotics. We searched Embase, MEDLINE, PsycINFO, PubMed, BIOSIS, Cochrane Central Register of Controlled Trials (CENTRAL), WHO International Clinical Trials Registry Platform, and ClinicalTrials.gov from database inception to Jan 8, 2019. Two authors independently selected studies and extracted data. We included randomised controlled trials in adults with acute symptoms of schizophrenia or related disorders. We excluded studies in patients with treatment resistance, first episode, predominant negative or depressive symptoms, concomitant medical illnesses, and relapse-prevention studies. Our primary outcome was change in overall symptoms measured with standardised rating scales. We also extracted data for eight efficacy and eight safety outcomes. Differences in the findings of the studies were explored in metaregressions and sensitivity analyses. Effect size measures were standardised mean differences, mean differences, or risk ratios with 95% credible intervals (CrIs). Confidence in the evidence was assessed using CINeMA (Confidence in Network Meta-Analysis). The study protocol is registered with PROSPERO, number CRD42014014919. Findings We identified 54 417 citations and included 402 studies with data for 53 463 participants. Effect size estimates suggested all antipsychotics reduced overall symptoms more than placebo (although not statistically significant for six drugs), with standardised mean differences ranging from −0·89 (95% CrI −1·08 to −0·71) for clozapine to −0·03 (−0·59 to 0·52) for levomepromazine (40 815 participants). Standardised mean differences compared with placebo for reduction of positive symptoms (31 179 participants) varied from −0·69 (95% CrI −0·86 to −0·52) for amisulpride to −0·17 (−0·31 to −0·04) for brexpiprazole, for negative symptoms (32 015 participants) from −0·62 (−0·84 to −0·39; clozapine) to −0·10 (−0·45 to 0·25; flupentixol), for depressive symptoms (19 683 participants) from −0·90 (−1·36 to −0·44; sulpiride) to 0·04 (−0·39 to 0·47; flupentixol). Risk ratios compared with placebo for all-cause discontinuation (42 672 participants) ranged from 0·52 (0·12 to 0·95; clopenthixol) to 1·15 (0·36 to 1·47; pimozide), for sedation (30 770 participants) from 0·92 (0·17 to 2·03; pimozide) to 10·20 (4·72 to 29·41; zuclopenthixol), for use of antiparkinson medication (24 911 participants) from 0·46 (0·19 to 0·88; clozapine) to 6·14 (4·81 to 6·55; pimozide). Mean differences compared to placebo for weight gain (28 317 participants) ranged from −0·16 kg (−0·73 to 0·40; ziprasidone) to 3·21 kg (2·10 to 4·31; zotepine), for prolactin elevation (21 569 participants) from −77·05 ng/mL (−120·23 to −33·54; clozapine) to 48·51 ng/mL (43·52 to 53·51; paliperidone) and for QTc prolongation (15 467 participants) from −2·21 ms (−4·54 to 0·15; lurasidone) to 23·90 ms (20·56 to 27·33; sertindole). Conclusions for the primary outcome did not substantially change after adjusting for possible effect moderators or in sensitivity analyses (eg, when excluding placebo-controlled studies). The confidence in evidence was often low or very low. Interpretation There are some efficacy differences between antipsychotics, but most of them are gradual rather than discrete. Differences in side-effects are more marked. These findings will aid clinicians in balancing risks versus benefits of those drugs available in their countries. They should consider the importance of each outcome, the patients' medical problems, and preferences. Funding German Ministry of Education and Research and National Institute for Health Research

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Sleep duration and risk of type 2 diabetes: a meta-analysis of prospective studies.

Zhilei Shan, Hongfei Ma, Manling Xie … (2015)

It remains unclear how many hours of sleep are associated with the lowest risk of type 2 diabetes. This meta-analysis was performed to assess the dose-response relationship between sleep duration and risk of type 2 diabetes.

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Author and article information

Contributors

Chin B. Eap: chin.eap@chuv.ch44

Journal

Journal ID (nlm-ta): BMC Psychiatry

Journal ID (iso-abbrev): BMC Psychiatry

Title: BMC Psychiatry

Publisher: BioMed Central (London )

ISSN (Electronic): 1471-244X

Publication date (Electronic): 17 May 2022

Publication date PMC-release: 17 May 2022

Publication date Collection: 2022

Volume: 22

Electronic Location Identifier: 342

Affiliations

[1 ]GRID grid.9851.5, ISNI 0000 0001 2165 4204, Unit of Pharmacogenetics and Clinical Psychopharmacology, Department of Psychiatry, , Centre for Psychiatric Neuroscience, Lausanne University Hospital, University of Lausanne, ; 1008 Prilly, Prilly, Switzerland

[2 ]GRID grid.8515.9, ISNI 0000 0001 0423 4662, Center for Psychiatric Epidemiology and Psychopathology, Department of Psychiatry, , Lausanne University Hospital, University of Lausanne, ; Prilly, Switzerland

[3 ]GRID grid.8515.9, ISNI 0000 0001 0423 4662, Prison Medicine and Psychiatry Service, Department of Psychiatry, , Lausanne University Hospital, University of Lausanne, ; Prilly, Switzerland

[4 ]GRID grid.150338.c, ISNI 0000 0001 0721 9812, Unit of Mood Disorders, Department of Psychiatry, , Geneva University Hospital, ; Geneva, Switzerland

[5 ]Les Toises Psychiatry and Psychotherapy Center, Lausanne, Switzerland

[6 ]GRID grid.8515.9, ISNI 0000 0001 0423 4662, Service of Child and Adolescent Psychiatry, Department of Psychiatry, , Lausanne University Hospital, University of Lausanne, ; Prilly, Switzerland

[7 ]GRID grid.8515.9, ISNI 0000 0001 0423 4662, Service of Old Age Psychiatry, Department of Psychiatry, , Lausanne University Hospital, University of Lausanne, ; Prilly, Switzerland

[8 ]GRID grid.8515.9, ISNI 0000 0001 0423 4662, Service of General Psychiatry, Department of Psychiatry, , Lausanne University Hospital, University of Lausanne, ; Prilly, Switzerland

[9 ]GRID grid.8591.5, ISNI 0000 0001 2322 4988, School of Pharmaceutical Sciences, , University of Geneva, University of Lausanne, ; Geneva, Switzerland

[10 ]GRID grid.9851.5, ISNI 0000 0001 2165 4204, Center for Research and Innovation in Clinical Pharmaceutical Sciences, , University of Lausanne, ; Lausanne, Switzerland

[11 ]GRID grid.9851.5, ISNI 0000 0001 2165 4204, Institute of Pharmaceutical Sciences of Western Switzerland, , University of Geneva, University of Lausanne, ; Lausanne, Switzerland

Article

Publisher ID: 3983

DOI: 10.1186/s12888-022-03983-3

PMC ID: 9116036

PubMed ID: 35581641

SO-VID: e2911185-9ab5-4614-8abd-48489ae46ef9

License:

Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

History

Date received : 24 January 2022

Date accepted : 4 May 2022

Funding

Funded by: Swiss National Research Foundation

Award ID: 320030-200602

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ScienceOpen disciplines: Clinical Psychology & Psychiatry

Keywords: psychiatry,insomnia disorders,metabolic syndrome,metabolic worsening,cardiovascular diseases

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ScienceOpen disciplines: Clinical Psychology & Psychiatry

Keywords: psychiatry, insomnia disorders, metabolic syndrome, metabolic worsening, cardiovascular diseases

Insomnia disorders are associated with increased cardiometabolic disturbances and death risks from cardiovascular diseases in psychiatric patients treated with weight-gain-inducing psychotropic drugs: results from a Swiss cohort

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Abstract

Study objectives

Methods

Results

Conclusions

Supplementary Information

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New Psychiatry

Most cited references 24

International classification of sleep disorders-third edition: highlights and modifications.

Comparative efficacy and tolerability of 32 oral antipsychotics for the acute treatment of adults with multi-episode schizophrenia: a systematic review and network meta-analysis

Sleep duration and risk of type 2 diabetes: a meta-analysis of prospective studies.

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