Antidepressant
For Sleep Apnea Helps, Study Shows
Experts
Cautious, Waiting For Large Studies
A study of a dozen
people with sleep apnea has found that an antidepressant taken
an hour before bedtime significantly reduced their sleep interruptions,
according to a report at the Associated Professional
Sleep Societies annual meeting.
The antidepressant,
called mirtazapine, cut in half the number of times breathing
stopped or slowed during sleep and reduced the number of times
sleep was disrupted by 28 percent among study participants.
It is the first time
such improvement has been shown using a medication, according
to David Carley and Dr. Miodrag Radulovacki, researchers at
the University of Illinois at Chicago who led the study.
"Our study shows the
largest and most consistent improvement in patients with sleep
apnea demonstrated by a drug treatment to date," says Carley,
who is the director of research at the University of Illinois
at Chicago Center for Sleep and Ventilatory Disorders.
Sleep apnea is a
disorder characterized by brief interruptions of breathing during
sleep, as many as 60 interruptions an hour, according to the
National Institutes of Health (NIH), which
estimates that approximately 18 million Americans suffer from
the disorder.
Signs of sleep apnea
are heavy snoring, disruption of sleep, and noticeable lapses
in breathing, the last often discovered by the partner
of a person with sleep apnea.
"There is no medical
therapy for sleep apnea, so the concept of treating it medically
is very attractive, but a study that small is very limited and
no conclusions can be drawn," says Dr. Eric Genden, surgical
director of the Program for Sleep Disorders at the Mount Sinai
Hospital in New York City.
Current
Therapy Offers Limited Help
Current therapy for
sleep apnea is a mask placed over the nose that is attached
to an air blower, which keeps pressure on the air passages to
remain open.
Surgery is also sometimes
done to remove adenoids, tonsils, or other soft tissue at the
back of the throat to help the breathing passages stay clear.
"The mask is difficult
to tolerate over a long period of time, so compliance rates
drop approximately 50 percent over the long run, and that's
a problem," Carley says.
"People know they
have sleep apnea, have tried the mask and given up, so an equally
effective but easier to tolerate treatment like a drug would
be a major step forward," he adds.
Antidepressant
Approach Is New
This small study is
the first to use the antidepressant to treat humans for sleep
apnea, Carley says. The new study followed a decade of animal
studies suggesting that serotonin antagonists could be helpful
in reducing sleep apnea symptoms.
"A multi-center study
would be the next necessary and logical step," he says, to further
determine the efficacy of the medication to treat sleep
apnea.
A recent study
conducted in Belgium of 154 people reported some improvement
in sleep patterns using mirtazapine.
That study looked
at insomnia among those suffering from depression. It found
that sleep efficiency increased by 7 percent in both depressed
and healthy people who took evening doses of mirtazipine compared
to those who took a placebo (inactive substance) or another
antidepressant called temazepam.
For the latest study,
researchers divided the study participants into three groups.
Each group took, on alternate weeks, a week-long prescription
of either a 4.5-milligram tablet of Remeron, a 15-milligram
tablet of the medicaton, or a placebo.
On the last night
of each week, participants spent the night in the sleep lab,
where they were monitored throughout the night for disordered
breathing, duration of the different stages of sleep, and sleep
position.
Carley and Dr. Radulovacki
found the drug at both doses reduced the number of breathing
disorders by an average of one half, and that the higher, 15-milligram
dose reduced the number of times sleep was disrupted by an average
of 28 percent. The lower dose of the drug did not reduce sleep
disruption.
Mirtazipine, sold
under the trade name Remeron, is manufactured by NV Organon,
of Roseland, N.J., which sponsored the study.
Remeron is currently
approved by the US Food and Drug Administration (FDA)
only for treatment of depression, and as yet the company has
not applied for FDA approval for Remeron use to treat sleep
apnea, Carley says.
Always consult your
physician for more information.
Online
Resources
(Our Organization
is not responsible for the content of Internet sites.)
American
Heart Association
American
Psychological Association
Associated
Professional Sleep Societies
Centers
for Disease Control and Prevention (CDC)
National
Institute of Neurological Disorders and Stroke
National
Institutes of Health (NIH)
National
Library of Medicine
US
Department of Heath and Human Services |
August 2004
Antidepressant
For Sleep Apnea Helps, Study Shows
Current
Therapy Offers Limited Help
Antidepressant
Approach Is New
What
Is Sleep Apnea?
Online
Resources
What
Is Sleep Apnea?
Sleep apnea is a serious,
potentially life-threatening condition that is far more common
than generally understood.
Sleep apnea occurs
in all age groups and both genders. It is more common in men,
although it may be under-diagnosed in women. It is estimated
that as many as 18 million US adults have sleep apnea.
Early recognition
and treatment of sleep apnea is important, as it may be associated
with the following:
Sleep apnea is a breathing
disorder characterized by brief interruptions of breathing during
sleep. There are two types of sleep apnea:
-
central
- occurs when the brain fails to send the appropriate
signals to the muscles to initiate breathing. Central
sleep apnea is less common than obstructive sleep apnea.
-
obstructive
- occurs when air cannot flow into or out of the person's
nose or mouth although efforts to breathe continue.
Sleep apnea seems
to run in some families, suggesting a possible genetic basis.
People most likely to have or develop sleep apnea include those
who:
Use of alcohol and
sleeping pills increases the frequency and duration of breathing
pauses in people with sleep apnea.
Sleep apnea is characterized
by a number of involuntary breathing pauses or "apneic events"
during a single night's sleep - may be as many as 20 to 30 or
more events per hour.
These events are almost
always accompanied by snoring between apneic episodes (although
not everyone who snores has sleep apnea). Sleep apnea may also
be characterized by choking sensations. The frequent interruptions
of deep, restorative sleep often lead to early morning headaches
and excessive daytime sleepiness.
Several tests are
available for evaluating a person for sleep apnea, including
the following:
-
polysomnography
- a test that records a variety of body functions during
sleep, such as the electrical activity of the brain, eye
movement, muscle activity, heart rate, respiratory effort,
air flow, and blood oxygen levels.
-
Multiple Sleep Latency
Test (MSLT) - a test that measures the speed
of falling asleep. People without sleep problems usually
take an average of 10 to 20 minutes to fall asleep. Individuals
who fall asleep in less than 5 minutes are likely to require
some type of treatment for sleep disorders.
Diagnostic tests usually
are performed in a sleep center, but new technology may allow
some sleep studies to be conducted in the patient's home.
Always consult your
physician for more information. |
