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Antidepressant May Ease Apnea

Posted on: Friday, 6 June 2003, 06:00 CDT

By Janice Billingsley, HealthScoutNews Reporter

HealthScoutNews -- A small study of a dozen people with sleep apnea has found that an antidepressant taken an hour before bedtime significantly reduces their sleep interruptions.

The antidepressant 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, and is the first time such improvement has been shown using a drug, say study authors David Carley and Dr. Miodrag Radulovacki, who are researchers at the University of Illinois at Chicago.

"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 director of research at the University of Illinois at Chicago Center for Sleep and Ventilatory Disorders.

The results of the study were presented June 5 at the annual meeting of the Associated Professional Sleep Societies in Chicago.

Carley says this small study is the first to use the antidepressant to treat humans for sleep apnea, and followed a decade of animal studies suggesting that serotonin antagonists could help reduce sleep apnea symptoms.

"A multi-center study would be the next necessary and logical step," he says, to further determine the efficacy of the drug to treat sleep apnea.

One larger study of 154 people that reported some improvement in sleep patterns using mirtazapine was recently completed in Belgium. That study, looking at insomnia among those suffering from depression, found that sleep efficiency increased by 7 percent in both depressed and healthy people who took evening doses of mirtazapine compared to those who took a placebo or another antidepressant called temazepam, which is sold as restoril. Researchers planned to present the results of that study at the sleep association meeting.

Mirtazapine, 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 U.S. Food and Drug Administration (FDA) only for treatment of depression, and as yet the company has not applied for FDA approval for Remeron to treat sleep apnea, Carley says.

"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.

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. 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 spouse of a person with sleep apnea.

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.

For the study, researchers divided the participants into three groups. Each group took, on alternate weeks, a weeklong prescription of a nightly pill of either a 4.5-milligram tablet of Remeron, a 15-milligram tablet of the drug 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 Radulovacki found the drug at both doses reduced the number of breathing disorders by an average of one half, and that the 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.

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On the Net:

National Institute of Neurological Disorders and Stroke

American Medical Association

University of Illinois at Chicago Center for Sleep and Ventilatory Disorders

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