Antidepressant Use Linked With Impaired REM Sleep, Quality of Life

Antidepressant use may contribute to impaired quality of life (QOL) due to reported links with increased REM sleep latency and REM deprivation, according to abstract findings presented at the CHEST 2021 Annual Meeting.

In assessing major determinants of sleep quality, prior research has indicated the depth of non-REM (NREM) sleep, the amount of REM sleep, and sleep continuity as 3 essential components.

With these factors contributing to sufficient total sleep time and sleep that is in synchrony with the sleep-wake circadian rhythm, impaired levels of REM sleep have been suggested to increase risk of mental health issues, insomnia, and risk of Parkinson disease.

Notably, antidepressants have been suggested to decrease REM sleep, which researchers say may affect patients’ QOL due to issues such as daytime sleepiness.

“Counterintuitively, prior research suggests that REM deprivation may actually decrease depressive symptoms, suggesting an improvement in QOL,” noted researchers.

Seeking to further assess the relationship between antidepressants, sleep, and QOL amid conflicting findings, they conducted a retrospective chart review study of 300 people with suspected sleep apnea who participated in sleep studies.

Sleep measurements of REM sleep, NREM sleep stage 1 (N1) (shallow or light sleep) and NREM sleep stage 2 (N2) (transition from light sleep to deep sleep), sleep latency, and total sleep time (TST) were examined.

In the analysis, demographics and comorbidities were considered, in which some participants were later diagnosed with obstructive sleep apnea (OSA) and others were not. Statistical analyses included t tests, analyses of variance, and χ² tests.

Among the participants taking antidepressants, less time in REM sleep (P = .023), more time in N1 (P = .002) and N2 sleep (P = .016), and increased TST (P = .005) were observed. Moreover, those taking antidepressants were associated with increased REM sleep latency (P = .000) and were more likely to completely lack REM sleep (P = .001).

Regarding QOL impact, presence of REM sleep was associated with better QOL (P = .031), whereas those taking antidepressants were more likely to have poorer QOL scores (P = 0.047). Older subjects were also more likely to have favorable QOL scores (P = .000).

“Given that REM sleep was associated with better QOL and that subjects taking antidepressants were more likely to have a lack of REM, it is possible that the poorer QOL scores in the antidepressant group are due to decreased REM,” said researchers. “This suggests that decreased REM sleep in patients on antidepressants is overall detrimental rather than therapeutic.”

For at-risk groups, age, antidepressant usage, hypertension, and chronic kidney disease were each independently found to have a significant negative correlation with amount of REM sleep.

“When caring for patients who take antidepressant medications, it is important to consider the potential effect on sleep and, therefore, QOL,” concluded researchers.

They added that further research is warranted to determine the impact of specific antidepressant classes, medication doses, and time of administration of antidepressants on sleep.

Reference

Allison S, Dalal B. Effect of antidepressants on rapid eye movement sleep and quality of life. CHEST. Published online October 1, 2021. doi:10.1016/j.chest.2021.07.2108