Psychiatric patients have higher rates of metabolic syndrome (MetS) and cardiovascular diseases (CVD) than the general population, with many contributing factors including psychiatric illness, and lifestyle (e.g., unhealthy diet, lack of physical activity, smoking, excessive alcohol use), clinical, and genetic factors. As a result, mental patients’ life expectancy is lowered by nearly ten years, with a death rate that is two to four times greater than the general population. Sleep disturbances are a widespread complaint among people of all ages, in both general and psychiatric populations, and are thus a serious public health issue. Sleep disorders are common in the general population, with prevalence estimates ranging from 35 to 52 per cent, and up to 90 per cent of depressed patients reporting sleep disturbances. The most common sleep problem is insomnia, which manifests as trouble beginning or maintaining sleep and/or non-restorative sleep in individuals suffering from depression, generalised anxiety, or post-traumatic stress disorder. Patients’ safety can be greatly harmed by the co-occurrence of mental and insomnia disorders, which increases the likelihood of relapse of psychiatric symptoms and even suicide.
Even though insomnia issues can have a significant impact on psychiatric patients, they are typically overlooked and not recorded in medical records. As a result, caregivers might concentrate on managing the primary psychiatric diagnosis, providing sedative drugs for sleep disorders, such as insomnia, and avoiding further in-depth investigations into the causes. Psychotropic medicines, on the other hand, may exacerbate or even cause sleep issues, with many antipsychotics producing restless leg syndrome, periodic limb movements, and/or weight gain, all of which are linked to sleep problems.
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As a result, sleep and psychological disorders are linked to increased metabolic abnormalities such as obesity, diabetes, hypertension, dyslipidemia, and MetS, which can lead to cardiovascular illnesses and early death. Many epidemiological investigations of sleep problems and metabolic abnormalities in the general population and psychiatric cohorts have been done. The evidence for a link between sleep-related breathing abnormalities, such as respiratory problems that occur while sleeping, and metabolic irregularities is compelling; however, this is not the case when it comes to non-organic sleep disorders, such as nonorganic insomnia. Participants with insomnia symptoms, such as difficulties beginning sleep, difficulty maintaining sleep, early morning awakening, and non-restorative sleep, had a greater risk of all-cause mortality than those who were symptom-free, according to a recent population-based cohort study. However, only a few small studies have focused on non-organic sleep abnormalities in the psychiatric community, and no study to our knowledge has particularly included patients taking weight-gain-inducing psychotropic drugs, who are at high risk for cardiometabolic changes. Furthermore, studies have used a single sleep measure as well as cardiometabolic measures, even though both may alter with time, particularly in this psychiatric population.
Insomnia problems and hyperglycemia were found to have the strongest relationship. As a result, patients with hyperglycemia were three and a half times more likely to suffer from sleeplessness. This link has been inconsistent in the literature due to the variety of these sleep problems and hyperglycemia classification, for example, certain research utilised diabetes mellitus while others used hyperglycemia. Insomnia problems, on the other hand, alter neuroendocrine system function by increasing sympathetic nerve activity, which reduces -cell responsiveness and increases cortisol release, resulting in insulin resistance and insulin reduction, respectively. Furthermore, insomnia disorders result in longer eating times, increased fatigue, and lower physical activity when associated with lower leptin and enhanced ghrelin levels, which boost the sense of hunger and appetite, as well as calorie intake, resulting in weight gain and diabetes, among other things. Furthermore, insomnia disorders may cause dysregulation of melanin-concentrating hormones, which are involved in the regulation of leptin and ghrelin levels, sleep, eating habits, and energy metabolism, as well as stress reactions, resulting in insulin resistance. Finally, psychiatric patients are more likely to be taken statins than the general population, which can lead to insulin resistance. In contrast, mental patients on psychotropic medications, particularly atypical antipsychotics, are more likely to develop diabetes, with complications such as polyuria, nocturia, polydipsia, diabetic neuropathy inducing restless leg syndrome, and diabetic retinopathy.
Finally, obstructive sleep apnea is strongly linked to cardiometabolic abnormalities, but only 8 inpatients had this information, therefore the variable could not be controlled for. In the absence of obstructive sleep apnea, however, insomnia difficulties are linked to a high BMI. Furthermore, eliminating patients with obstructive sleep apnea did not affect our findings.
The current study, which included a large cohort of psychiatric patients treated with weight-gain-inducing psychotropic drugs, found clinically significant links between insomnia disorders and various metabolic disturbances such as obesity, central obesity, hypertension, hyperglycemia, and metabolic syndrome, and the risk of dying from CVD within ten years. Future research should show whether better characterization and therapy of insomnia disorders can prevent the deterioration of cardiometabolic parameters in a psychiatric population at high risk of metabolic disturbances, or if better metabolic health can enhance sleep quantity and/or quality.
