Advance taper of antidepressants prior to multiple sleep latency testing increases the number of sleep-onset rapid eye movement periods and reduces mean sleep latency

Patients presenting with excessive sleepiness are frequently using antidepressant medication(s). While practice parameters recommend discontinuation of antidepressants prior to multiple sleep latency testing (MSLT), data examining the impact of tapering these medications on MSLT results are limited. Adult patients who underwent MSLT at Mayo Clinic Rochester, Minnesota, between 2014 and 2018 were included. Clinical and demographic characteristics, medications, including use of rapid eye movement-suppressing antidepressants (REMS-ADs) at assessment and during testing, actigraphy, and polysomnography data were manually abstracted. The difference in number of sleep-onset rapid eye movement periods (SOREMs), proportion with ≥2 SOREMs, and mean sleep latency in patients who were using REMS-ADs and discontinued prior to testing versus those who remained on REMS-ADs were examined. At our center, all antidepressants are discontinued 2 weeks prior to MSLT, wherever feasible; fluoxetine is stopped 6 weeks prior. Regression analyses accounting for demographic, clinical, and other medication-related confounders were performed. A total of 502 patients (age = 38.18 ± 15.90 years; 67% female) underwent MSLT; 178 (35%) were taking REMS-ADs at the time of assessment. REMS-AD was discontinued prior to MSLT in 121/178 (70%) patients. Patients whose REMS-AD was discontinued prior to MSLT were more likely to have ≥2 SOREMs (odds ratio: 12.20; 95% confidence interval: 1.60-92.94) compared with patients on REMS-ADs at MSLT. They also had shorter mean sleep latency (8.77 ± 0.46 vs 10.21 ± 0.28 minutes; P > .009) and higher odds of having ≥2 SOREMs (odds ratio: 2.22; 95% confidence interval: 1.23-3.98) compared with patients not taking REMS-ADs at initial assessment. These differences persisted after regression analyses accounting for confounders. Patients who taper off REMS-ADs prior to MSLT are more likely to demonstrate ≥2 SOREMs and have a shorter mean sleep latency. Pending further prospective investigations, clinicians should preferably withdraw REMS-ADs before MSLT. If this is not done, the test interpretation should include a statement regarding the potential effect of the drugs on the results.