Lipid-lowering agent use and changes to sleep

There is mixed evidence as to whether lipid-lowering agents impact sleep, with some patients reporting significant sleep disruption after starting these medications. Our objective was to determine the relationship between use of lipid-lowering agents and objective measures of sleep quality recorded via in-laboratory polysomnography.

In this cross-sectional retrospective study, we examined data from patients who underwent diagnostic in-laboratory polysomnography at Sunnybrook Sleep Laboratory, an academic tertiary care sleep center. Self-reported questionnaires were used to ascertain use of any lipid-lowering agent and medical comorbidities. Multivariable linear regression models were utilized to analyze the association between use of lipid-lowering agents, including specific classes, with objective polysomnography-derived measures of sleep (i.e. sleep efficiency, total sleep time, REM latency, sleep onset latency, and wake time after sleep onset).

We included 3754 patients (mean age±SD = 54.7 ± 16.4 years; 47.5% male; mean BMI±SD = 29.0 ± 6.64 kg/m²). Overall, 1055 patients were found to be using lipid-lowering agents with atorvastatin being the most common, followed by rosuvastatin, cholesterol absorption inhibitors, simvastatin, pravastatin, fibrates, and bile acid sequestrants. After adjusting for age, sex, body mass index, relevant comorbidities, obstructive sleep apnea and its severity, habits that worsen sleep, and other medication classes that impact sleep, the use of atorvastatin was found to significantly decrease sleep efficiency (β = -1.95; 95% CI = -3.71 to -0.19; p = 0.030). The use of other lipid-lowering agents, regardless of medication class, did not significantly impact sleep.

The use of atorvastatin may be associated with negative impacts to patients' sleep, though the magnitude of change is small. Clinicians should be aware of these effects and counsel patients accordingly.