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
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
Other
Resources:
Find
a St. John's Mercy Physician
St.
John's Mercy Center for New Health Options
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Health Information
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John's Mercy Classes and Programs
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.
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