BALTIMORE—Lurasidone may increase individuals’ total sleep time by an average of 28 minutes, according to research presented at the 27th Annual Meeting of the Associated Professional Sleep Societies. The drug, which is approved for the treatment of psychotic conditions, appears to increase the amount of stage two sleep without affecting slow-wave sleep or REM sleep.
When investigators restricted their analysis to participants with disturbed sleep, they found that the drug had significant effects on all study variables (eg, wake after sleep onset and sleep efficiency) except latency to persistent sleep. “There was really no effect on sleep onset in this study at all,” said Andrew D. Krystal, MD, Professor of Psychiatry and Behavioral Sciences at the Duke University School of Medicine in Durham, North Carolina.
Disturbing Sleep in Healthy Controls
Dr. Krystal and colleagues enrolled 54 healthy subjects (50% women) ages 21 to 65 to evaluate lurasidone in a two-site, placebo-controlled, crossover study. Participants were randomized to 40 mg of lurasidone or placebo. Subjects spent one night in a sleep laboratory to ensure that the night before the intervention was standardized. On the following night, participants went to bed four hours before their usual bedtime and were given the intervention 30 minutes before going to bed. At 30 minutes after waking and at three hours after waking, Dr. Krystal and colleagues assessed subjects’ sleepiness using a standard test battery that included a digit symbol substitution test and a symbol copying test.
Eligible participants reported having regular sleep times, times in bed, and bedtimes before the study began. The researchers monitored the subjects during the initial assessment phase of the study with actigraphy and diaries to confirm the subjects’ reports. The investigators administered the Epworth Sleepiness Scale and multiple sleep latency testing (an objective test of sleepiness) to confirm that subjects were not sleep deprived and carried out polysomnography to rule out sleep apnea and periodic leg movements, respectively, among participants.
Lurasidone’s Sleep–Wake Effects May Be Unique Among Antipsychotics
The study paradigm was associated with a 39-minute decrease in total sleep time. In addition, the paradigm also led to increased latency to sleep onset and increased wake after sleep onset. On the other hand, the paradigm did not appear to affect participants’ number of awakenings per night.
Lurasidone improved artificially disturbed sleep in healthy volunteers, “but this effect is unique for this paradigm because it didn’t have benefit in onset,” said Dr. Krystal. “It did have a potent effect on sleep maintenance. We don’t know what would happen if this drug were dosed in a person who went to bed at his or her usual bedtime. It may or may not help sleep onset,” he added.
Among antipsychotic agents, lurasidone “possibly has uniquely therapeutic sleep–wake effects,” said Dr. Krystal. Few antipsychotic agents have been studied in a similar paradigm, and most of them are considered to cause daytime sedation. Lurasidone did not cause sedation, but it was associated with improved sleep maintenance. The drug “may be useful in patients with mood disorders or thought disorders,” Dr. Krystal concluded.
—Erik Greb
Senior Associate Editor