Respiratory dysfunction in sleep apnea associated with quetiapine

Area of Science:

• Pharmacology
• Pulmonology
• Sleep Medicine

Background:

• Quetiapine, an atypical antipsychotic, is generally well-tolerated.
• Recent reports suggest a link between quetiapine use and respiratory dysfunction.
• Sleep apnea syndrome (SAS) is a common condition, particularly in obese individuals.

Observation:

• Two cases of moderate to severe respiratory dysfunction in obese patients with SAS using standard oral quetiapine doses are presented.
• Case 1: Acute respiratory failure and coma after a single dose of quetiapine with lorazepam in a patient with undiagnosed SAS.
• Case 2: Nocturnal respiratory dysfunction and confusion in a patient with operated obstructive SAS treated with quetiapine.

Findings:

• Quetiapine, even at normal doses, can precipitate significant respiratory compromise in patients with SAS.
• The risk appears elevated in obese patients and when co-administered with benzodiazepines like lorazepam.
• Mechanical ventilation was required for recovery in one case, highlighting the potential severity.

Implications:

• Clinicians should exercise caution when prescribing quetiapine to patients with suspected or known SAS, especially if obese.
• Close monitoring of respiratory function is crucial in these patients.
• Consideration of alternative antipsychotics or dose adjustments may be warranted in high-risk individuals.