Relationships between sleep patterns and metabolic profile in patients maintained on antipsychotics: a cross-sectional comparative study

Figures & data

Table 1 Sample characteristics by illness and treatment groups

	HC (n=126)	MD+AP (n=112)	MD/noAP (n=101)
Age (mean ± SD)	35.05±8.17	35.73±10.28	34.16±8.93
Gender n (%)
Male	72 (57.1%)	73 (65.2%)	74 (73.3%)*
Female	54 (42.9%)‡	39 (34.8%)	27 (26.7%)
Nationality n (%)
Qatari	22 (17.5%)	52 (46.4%)*‡	20 (19.8%)
Arab (non-Qatari)	35 (27.8%)	27 (24.1%)	19 (18.8%)
South Asian	57 (45.2%)+	24 (21.4%)	43 (42.6%)+
Other	12 (9.5%)	9 (8.0%)	19 (18.8%)
Marital status n (%)
Single	35 (27.8%)	57 (50.9%)*	44 (43.6%)*
Married	90 (71.4%)^†‡	43 (38.4%)	53 (52.5%)
Divorced/Widowed	1 (0.8%)	12 (10.7%)*	4 (4.0%)
Education n (%)
None	4 (3.2%)	4 (3.6%)	8 (8.0%)
Elementary/Intermediate	20 (16.0%)	35 (31.5%)*	37 (37.0%)*
Secondary	29 (23.2%)	37 (33.3%)	25 (25.0%)
Vocational/College/Graduate	72 (57.6%)^†‡	35 (31.5%)	30 (30.0%)
Employment n (%)
Employed	116 (94.3%)^†‡	47 (42.0%)	73 (72.3%)^†
Unemployed	7 (5.7%)	65 (58.0%)*‡	28 (27.7%)*
Smoker n (%) Yes	27 (21.4%)	58 (51.8%)*	47 (46.5%)*
BMI (kg/m^2) (mean ± SD)	27.66±5.24‡	29.12±6.95‡	24.56±5.29
SBP (mm Hg) (mean ± SD)	120.19±15.46	127.92±13.56*	130.25±12.91*
DBP (mm Hg) (mean ± SD)	74.77±12.34	81.44±10.70*	82.25±11.35*
FBG (mmol/L) (mean ± SD)	5.65±2.08	6.28±4.94	5.71±1.39
HDL (mmol/L) (mean ± SD)	1.22±0.44	1.22±0.32	1.27±0.50
TGs (mmol/L) (mean ± SD)	1.50±0.99	1.60±1.06	1.60±1.44
Waist (cm) (mean ± SD)	90.94±13.91	97.24±14.09*‡	87.25±14.73
Weight (kg) (mean ± SD)	74.81±14.48‡	81.22±18.91*‡	68.16±15.33
MetS (IDF) n (%)	36 (28.6%)	40 (35.7%)	22 (21.8%)

Notes: *Higher than the control group; ^†higher than the MD+AP group; ‡higher than the MD/noAP group (p<0 0.05).

Abbreviations: HC, healthy controls; MD, mental disorder; AP, antipsychotics; SD, standard deviation; BMI, body mass index; SBP, systolic blood pressure; DSP, diastolic blood pressure; FBG, fasting blood glucose; HDL, high density lipoproteins; TG, triglycerides; MetS, metabolic syndrome; IDF, international diabetes federation.

Table 2 Psychiatric and medication profiles of patients’ groups

	MD+AP (n=112)	MD/noAP (n=101)
Psychiatric diagnosis, n (%)
Schizophrenia spectrum	46 (41.07%)	49 (48.51%)
Psychosis NOS	3 (2.68%)	12 (11.88%)
Depression	8 (7.14%)	9 (8.91%)
Bipolar	45 (40.18%)‡	19 (18.81%)
Mood NOS	3 (2.68%)	7 (6.93%)
OCD	3 (2.68%)	2 (1.98%)
Personality	4 (3.57%)	3 (2.97%)
Duration of illness (years) (Median ± IQR)	10±11.50‡	3±5
Number of psychiatric hospitalizations (Median ± IQR)	3±3‡	1±1
History of suicide attempts, n (%)	26 (23.21%)	18 (17.82%)
Oral hypoglycemics (n)	8	2
Antihypertensives (n)	3	2
Antidepressants (n)	12	4
Sodium valproate (n)	9	-
SGA (n) (CBZ equivalent AP dose) (Median ± IQR)
Aripiprazole	17 (364.25±0.00)	-
Paliperidone	6 (401.33±517.24)	-
Risperidone	36 (253.05±172.41)	-
Olanzapine	43 (240.68±150.60)	-
Quetiapine	12 (67.15±282.19)	-
Clozapine	4 (80.08±109.25)	-
FGA (n) (CBZ equivalent AP dose) (Median ± IQR)
Haloperidol	15 (249.38±217.39)	-
Flupenthixol*	3	-
Zuclopenthixol*	2	-

Notes: *These AP were given as depot injection; ‡higher than the MD/noAP group (p<0.05).

Abbreviations: NOS, not otherwise specified; OCD, obsessive compulsive disorder; IQR, interquartile range; FGA, first generation antipsychotics; SGA, second generation antipsychotics; AP, antipsychotics.

Table 3 Sleeping patterns by illness and treatment groups

	HC (n=126)	MD+AP (n=112)	MD/noAP (n=101)
Total number of hours slept (mean ± SD)	7.56±1.47	9.17±2.08*	8.63±2.15*
Groups of hours slept, n (%)
7–8h	68 (54.0%)^†‡	35 (31.8%)	34 (33.7%)
<7h	30 (23.8%)^†	8 (7.3%)	16 (15.8%)
>8h	28 (22.2%)	67 (60.9%)*	51 (50.5%)*
Difficulty falling asleep, n (%)	20 (16.0%)	31 (28.2%)	31 (30.7%)*
Early wakeup,n (%)	31 (24.8%)	34 (30.9%)	27 (27.3%)
Difficulty falling back into sleep n (%)	21 (16.7%)	23 (21.1%)	26 (26.3%)
Tiredness/sleepiness, n (%)	37 (29.6%)	38 (34.9%)	37 (36.6%)
Problems during sleep, n (%)	26 (21.3%)	42 (38.5%)*‡	23 (23.2%)
Participants’ rating of sleep quality, n (%)
1	4 (3.2%)	5 (4.5%)	4 (4.0%)
2	6 (4.8%)	8 (7.3%)	8 (8.1%)
3	27 (21.4%)	27 (24.5%)	28 (28.3%)
4	46 (36.5%)	35 (31.8%)	23 (23.2%)
5	43 (34.1%)	35 (31.8%)	36 (36.4%)
Sleep score (mean ± SD)	2.70±2.20	3.41±2.07	3.29±2.53

Notes: *Higher than the control group; ^†higher than the MD+AP group; ‡higher than the MD/noAP group (p<0.05).

Abbreviations: HC, healthy controls; MD, mental disorder; AP, antipsychotics; SD, standard deviation.

Table 4 Sample characteristics by sleep duration groups

	7–8 h (n=137)	<7 h (n=54)	>8 h (n=146)
Age (mean ± SD)	36.37±9.29	33.06±8.88	34.52±8.96
Gender, n (%)
Male	96 (70.1%)	36 (66.7%)	85 (58.2%)
Female	41 (29.9%)	18 (33.3%)	61 (41.8%)
Nationality, n (%)
Qatari	29 (21.2%)	7 (13.0%)	56 (38.4%)*^†
Arab (non-Qatari)	34 (24.8%)	16 (29.6%)	31 (21.2%)
South Asian	63 (46.0%)‡	22 (40.7%)	39 (26.7%)
Other	11 (8.0%)	9 (16.7%)	20 (13.7%)
Employment, n (%)
Employed	107 (79.3%)‡	47 (88.7%)‡	81 (55.5%)
Unemployed	28 (20.7%)	6 (11.3%)	65 (44.5%)*^†
Smoker, n (%) Yes	48 (35.0%)	17 (31.5%)	65 (44.5%)
BMI (kg/m^2) (mean ± SD)	27.10±6.02	25.17±4.43	28.04±6.58^†
SBP (mm Hg) (mean ± SD)	126.47±14.95	123.41±15.69	125.77±12.91
DBP (mm Hg) (mean ± SD)	80.03±12.61	76.09±12.10	79.50±11.32
FBG (mmol/L) (mean ± SD)	5.88±2.23	5.48±1.49	6.02±4.30
HDL (mmol/L) (mean ± SD)	1.24±0.51	1.23±0.33	1.23±0.37
TGs (mmol/L) (mean ± SD)	1.70±1.39	1.31±0.81	1.50±0.98
Waist (cm) (mean ± SD)	90.73±13.26	86.34±12.41	94.43±16.11^†
Weight (kg) (mean ± SD)	74.14±16.40	69.98±12.43	77.21±18.46^†
MetS (IDF), n (%) Met	43 (31.4%)	10 (18.5%)	44 (30.1%)
Type of MD, n (%)
None	68 (49.6%)‡	30 (55.6%)‡	28 (19.2%)
Psychotic disorders	32 (23.4%)	15 (27.8%)	54 (37.0%)*
Mood disorders	34 (24.8%)	8 (14.8%)	51 (34.9%)^†
Others	3 (2.2%)	1 (1.9%)	13 (8.9%)*
Type of Antipsychotics, n (%)
None	102 (74.5%)‡	46 (85.2%)‡	79 (54.1%)
First generation	4 (2.9%)	3 (5.6%)	8 (5.5%)
Second generation	26 (19.0%)	4 (7.4%)	46 (31.5%)*^†
Both	5 (3.6%)	1 (1.9%)	13 (8.9%)

Note: *Higher than the 7–8 h; ^†higher than the <7 h group; ‡higher than the >8h group (p<0.05).

Abbreviations: HC, healthy controls; MD, mental disorder; SD, standard deviation; BMI, body mass index; SBP, systolic blood pressure; DSP, diastolic blood pressure; FBG, fasting blood glucose; HDL, high density lipoproteins; TGs, triglycerides; MetS, metabolic syndrome; IDF, international diabetes federation.

Table 5 Factors associated with longer sleep duration using multinomial logistic regression

		Odds ratio	95% Confidence interval		p-value
			Lower	Upper
<7 hrs	Gender (Ref: Male)	0.934	0.944	0.451	1.934
	Subject group: MD/noAP (Ref: HC)	0.940	1.319	0.433	2.042
	Subject group: MD+AP (Ref: HC)	0.508	1.230	0.199	1.296
	Waist circumference (cm)	0.978	1.004	0.953	1.004
>8 hrs	Gender (Ref: Male)	2.119	1.222	3.674	0.008
	Subject group: MD/noAP (Ref: HC)	4.080	2.111	7.887	0.000
	Subject group: MD+AP (Ref: HC)	4.282	2.263	8.103	0.000
	Waist circumference (cm)	1.019	1.001	1.038	0.041

Abbreviations: Ref, reference group; MD, mental disorder; AP, antipsychotics; HC, healthy controls.

Table S1 Sleep questionnaire

Questions
1	How many hours do you, on average, sleep per day?
2	Do you usually take naps during the day?
3	Approximately how long is your nap?
4	Do you often have difficulties falling asleep?
5	Do you wake up earlier than you want?
6	Do you often wake up after a short sleep and then have difficulty falling asleep again?
7	Do you often feel tired/ sleepy during the day?
8	Has anybody told you that you have any problems during sleep, like snoring, difficulty breathing, sleepwalking or others?
9	What kind of problems during sleep do you have?
10	How do you grade your sleep quality over the last six months?

Table S2 Calculation of sleep score

Component	Questions	Responses	Sleep scoring
1. Subjective sleep quality (C1)	12. How would you rate the quality of your sleep over the last six months? 1= Poor, 5= Excellent	1	4
		2	3
		3	2
		4	1
		5	0
2. Sleep latency (C2)	6. Do you often have difficulties falling asleep?	Yes	1
		No	0
3. Sleep duration (C3)	1. How many hours do you on average sleep per day? 5. Approximately how long is your nap?	Add number of hours slept at night and nap duration
		<7	1
		7–8	0
		>8	1
4. Sleep disturbances (C4)	7, 8 & 10 7. Do you wake up earlier than you want? 8. Do you often wake up after a short sleep and then have a difficulty falling asleep again? 10. Has anybody told you that you have problems during sleep, like snoring, difficulty breathing, sleepwalking or others?	Q7, Q8 & Q10:
		Yes	1
		No	0
		Sum of Q7, Q8 & Q10 scores:
		0	0
		1	1
		2	2
		3	3
5. Daytime dysfunction (C5)	9. Do you often feel tired/ sleepy during the day?	Yes	1
		No	0
Total Sleep Score = C1+C1+C3+C4+C5

Data Availability Statement

In order to protect the privacy and confidentiality of the research participants, our de-identified data is available only upon request and after compliance with the policies and procedures of WCM-Qatar, HMC and QNRF for data sharing. Requests can be submitted to Hassen Al-Amin at [email protected].