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Shahbazi M, Heidari R, Tafakhori A, Samadi S, Nikeghbalian Z, Amirifard H, Najafi A. The effects of atomoxetine and trazodone combination on obstructive sleep apnea and sleep microstructure: A double-blind randomized clinical trial study. Sleep Med 2024; 113:13-18. [PMID: 37979502 DOI: 10.1016/j.sleep.2023.11.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2023] [Revised: 10/30/2023] [Accepted: 11/02/2023] [Indexed: 11/20/2023]
Abstract
STUDY OBJECTIVES we aimed to compare the effects of atomoxetine and trazodone (A-T) in combination with placebo in patients with obstructive sleep apnea (OSA). METHODS This randomized, placebo-controlled, double-blind, crossover trial study was conducted in adults with OSA referred to a Sleep Clinic. Participants with eligibility criteria were recruited. Patients were studied on two separate nights with one-week intervals, once treated with trazodone (50 mg) and atomoxetine (80 mg) combination and then with a placebo and the following polysomnography tests. RESULTS A total of 18 patients with OSA completed the study protocol, 9(50%) were male, the mean age was 47.5 years (SD = 9.8) and the mean Body mass index of participants was 28.4 kg/m2 (SD = 3.4). Compared with the placebo, the A-T combination resulted in significant differences in AHI (28.3(A-T) vs. 42.7 (placebo), p = 0.025), duration of the REM stage (1.3%TST (A-T) vs. 13.1%TST (placebo), p = 0.001), and the number of REM cycles (0.8 (A-T) vs. 4.7 (placebo), p = 0.001), number of apneas (38.3 (A-T) vs. 79.3 (placebo), p = 0.011), number of obstructive apneas (37.2 (A-T) vs. 75.2 (placebo), p = 0.011), oxygen desaturation index (29.5 (A-T) vs. 42.3 (placebo), p = 0.022) and number of respiratory arousals (43.2 (A-T) vs. 68.5 (placebo), p = 0.048). This decrement effect did not change among those with a low-arousal phenotype of OSA. CONCLUSIONS The A-T combination significantly improved respiratory events' indices compared with placebo in patients with OSA. This combination is recommended to be assessed in a large trial. It could be an alternative for those who do not adhere to the standard available treatments for OSA.
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Affiliation(s)
- Mojtaba Shahbazi
- Iranian Center of Neurological Research, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Reihaneh Heidari
- Otolaryngology Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Abbas Tafakhori
- Iranian Center of Neurological Research, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Shahram Samadi
- Sleep Breathing Disorders Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Zahra Nikeghbalian
- Occupational Sleep Research Center, Baharloo Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Hamed Amirifard
- Iranian Center of Neurological Research, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran; Occupational Sleep Research Center, Baharloo Hospital, Tehran University of Medical Sciences, Tehran, Iran.
| | - Arezu Najafi
- Sleep Breathing Disorders Research Center, Tehran University of Medical Sciences, Tehran, Iran; Occupational Sleep Research Center, Baharloo Hospital, Tehran University of Medical Sciences, Tehran, Iran
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Wieckiewicz M, Martynowicz H, Lavigne G, Lobbezoo F, Kato T, Winocur E, Wezgowiec J, Danel D, Wojakowska A, Mazur G, Smardz J. An exploratory study on the association between serotonin and sleep breathing disorders. Sci Rep 2023; 13:11800. [PMID: 37479853 PMCID: PMC10362063 DOI: 10.1038/s41598-023-38842-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2023] [Accepted: 07/16/2023] [Indexed: 07/23/2023] Open
Abstract
This exploratory observational study aimed to evaluate whether the blood levels of serotonin and enzymes involved in serotonin synthesis are associated with sleep breathing parameters. A total of 105 patients were included in this study, who were subjected to single-night polysomnography with simultaneous audio-video recordings. Peripheral blood samples were collected to estimate the serum levels of serotonin, tryptophan hydroxylase 1 (TPH1), and aromatic l-amino acid decarboxylase (AADC). Results showed a negative correlation between blood serotonin levels, and oxygen desaturation index (ODI) (p = 0.027), central apnea (p = 0.044) and obstructive apnea (OA) (p = 0.032) scores. Blood TPH1 levels were negatively correlated with average (p = 0.003) and minimal saturation (p = 0.035) and positively correlated with apnea-hypopnea index (p = 0.010), OA (p = 0.049), and hypopnea index (p = 0.007) scores. A tendency to sleep-disordered breathing seemed to co-occur with lower blood serotonin and higher TPH1 levels.Clinical Trial Registration : www.ClinicalTrials.gov , identifier NCT04214561.
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Affiliation(s)
- Mieszko Wieckiewicz
- Department of Experimental Dentistry, Wroclaw Medical University, Wroclaw, Poland.
| | - Helena Martynowicz
- Department and Clinic of Internal Medicine, Occupational Diseases, Hypertension and Clinical Oncology, Wroclaw Medical University, Wroclaw, Poland
| | - Gilles Lavigne
- Faculty of Dental Medicine, Universite de Montreal, CIUSSS Nord Ile de Montreal and CHUM, Montreal, Canada
| | - Frank Lobbezoo
- Department of Orofacial Pain and Dysfunction, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Takafumi Kato
- Department of Oral Physiology, Osaka University Graduate School of Dentistry, Suita, Japan
| | - Efraim Winocur
- Department of Oral Rehabilitation, The Maurice and Gabriela Goldschleger School of Dental Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Joanna Wezgowiec
- Department of Experimental Dentistry, Wroclaw Medical University, Wroclaw, Poland
| | - Dariusz Danel
- Department of Anthropology, Hirszfeld Institute of Immunology and Experimental Therapy, Polish Academy of Sciences, Wroclaw, Poland
| | - Anna Wojakowska
- Department and Clinic of Internal Medicine, Occupational Diseases, Hypertension and Clinical Oncology, Wroclaw Medical University, Wroclaw, Poland
| | - Grzegorz Mazur
- Department and Clinic of Internal Medicine, Occupational Diseases, Hypertension and Clinical Oncology, Wroclaw Medical University, Wroclaw, Poland
| | - Joanna Smardz
- Department of Experimental Dentistry, Wroclaw Medical University, Wroclaw, Poland
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Mohit, Tomar MS, Araniti F, Pateriya A, Singh Kushwaha RA, Singh BP, Jurel SK, Singh RD, Shrivastava A, Chand P. Identification of metabolic fingerprints in severe obstructive sleep apnea using gas chromatography-Mass spectrometry. Front Mol Biosci 2022; 9:1026848. [PMID: 36504723 PMCID: PMC9732946 DOI: 10.3389/fmolb.2022.1026848] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Accepted: 11/02/2022] [Indexed: 11/22/2022] Open
Abstract
Objective: Obstructive sleep apnea (OSA) is considered a major sleep-related breathing problem with an increasing prevalence rate. Retrospective studies have revealed the risk of various comorbidities associated with increased severity of OSA. This study aims to identify novel metabolic biomarkers associated with severe OSA. Methods: In total, 50 cases of OSA patients (49.74 ± 11.87 years) and 30 controls (39.20 ± 3.29 years) were included in the study. According to the polysomnography reports and questionnaire-based assessment, only patients with an apnea-hypopnea index (AHI >30 events/hour) exceeding the threshold representing severe OSA patients were considered for metabolite analysis. Plasma metabolites were analyzed using gas chromatography-mass spectrometry (GC-MS). Results: A total of 92 metabolites were identified in the OSA group compared with the control group after metabolic profiling. Metabolites and their correlated metabolic pathways were significantly altered in OSA patients with respect to controls. The fold-change analysis revealed markers of chronic kidney disease, cardiovascular risk, and oxidative stress-like indoxyl sulfate, 5-hydroxytryptamine, and 5-aminolevulenic acid, respectively, which were significantly upregulated in OSA patients. Conclusion: Identifying these metabolic signatures paves the way to monitor comorbid disease progression due to OSA. Results of this study suggest that blood plasma-based biomarkers may have the potential for disease management.
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Affiliation(s)
- Mohit
- Department of Prosthodontics, Faculty of Dental Sciences, King George’s Medical University, Lucknow, India,Center for Advance Research, Faculty of Medicine, King George’s Medical University, Lucknow, India
| | - Manendra Singh Tomar
- Center for Advance Research, Faculty of Medicine, King George’s Medical University, Lucknow, India
| | - Fabrizio Araniti
- Dipartimento di Scienze Agrarie e Ambientali, Produzione, Territorio, Agroenergia (DiSAA), University of Milan, Milan, Italy
| | - Ankit Pateriya
- Center for Advance Research, Faculty of Medicine, King George’s Medical University, Lucknow, India
| | - Ram Awadh Singh Kushwaha
- Department of Respiratory Medicine, Faculty of Medicine, King George’s Medical University, Lucknow, India
| | | | - Sunit Kumar Jurel
- Department of Prosthodontics, Faculty of Dental Sciences, King George’s Medical University, Lucknow, India
| | - Raghuwar Dayal Singh
- Department of Prosthodontics, Faculty of Dental Sciences, King George’s Medical University, Lucknow, India
| | - Ashutosh Shrivastava
- Center for Advance Research, Faculty of Medicine, King George’s Medical University, Lucknow, India,*Correspondence: Ashutosh Shrivastava, ; Pooran Chand,
| | - Pooran Chand
- Department of Prosthodontics, Faculty of Dental Sciences, King George’s Medical University, Lucknow, India,*Correspondence: Ashutosh Shrivastava, ; Pooran Chand,
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Abstract
Despite extensive research, there is currently no approved drug for obstructive sleep apnea (OSA) treatment. OSA is a heterogeneous condition that involves multiple dominating pathophysiological traits. Drug development in this field needs to address both pathophysiological mechanisms and associated comorbid conditions in order to meet requirements for long-term therapy in OSA. Several drug candidates have been proposed and ongoing phase II trials that target various forms of sleep-disordered breathing have been initiated. The field is moving toward tailored therapeutic approaches in patients with OSA.
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Thomson LDJ, Landry SA, Joosten SA, Mann D, Wong A, Cheung T, Adam M, Beatty C, Hamilton GS, Edwards BA. A single dose of noradrenergic/serotonergic reuptake inhibitors combined with an antimuscarinic does not improve obstructive sleep apnoea severity. Physiol Rep 2022; 10:e15440. [PMID: 36029192 PMCID: PMC9419156 DOI: 10.14814/phy2.15440] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2022] [Accepted: 08/05/2022] [Indexed: 06/15/2023] Open
Abstract
Previous trials have demonstrated that the combination of noradrenergic reuptake inhibitors with an antimuscarinic can substantially reduce the apnoea-hypopnoea index (AHI) and improve airway collapsibility in patients with obstructive sleep apnoea (OSA). However, some studies have shown that when administered individually, neither noradrenergic or serotonergic agents have been effective at alleviating OSA. This raises the possibility that serotonergic agents (like noradrenergic agents) may also need to be delivered in combination to be efficacious. Therefore, we investigated the effect of an antimuscarinic (oxybutynin) on OSA severity when administered with either duloxetine or milnacipran, two dual noradrenergic/serotonergic reuptake inhibiters. A randomized, double-blind, 4 way cross-over, placebo-controlled trial in ten OSA patients was performed. Patients received each drug condition separately across four overnight in-lab polysomnography (PSG) studies ~1-week apart. The primary outcome measure was the AHI. In addition, the four key OSA endotypes (collapsibility, muscle compensation, arousal threshold, loop gain) were measured non-invasively from the PSGs using validated techniques. There was no significant effect of either drug combinations on reducing the total AHI or improving any of the key OSA endotypes. However, duloxetine+oxybutynin did significantly increase the fraction of hypopnoeas to apnoeas (FHypopnoea ) compared to placebo (p = 0.02; d = 0.54). In addition, duloxetine+oxybutynin reduced time in REM sleep (p = 0.009; d = 1.03) which was positively associated with a reduction in the total AHI (R2 = 0.62; p = 0.02). Neither drug combination significantly improved OSA severity or modified the key OSA endotypes when administered as a single dose to unselected OSA patients.
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Affiliation(s)
- Luke D. J. Thomson
- Department of Physiology, School of Biomedical Sciences and Biomedical Discovery InstituteMonash UniversityMelbourneVictoriaAustralia
- Turner Institute for Brain and Mental HealthMonash UniversityMelbourneVictoriaAustralia
| | - Shane A. Landry
- Department of Physiology, School of Biomedical Sciences and Biomedical Discovery InstituteMonash UniversityMelbourneVictoriaAustralia
- Turner Institute for Brain and Mental HealthMonash UniversityMelbourneVictoriaAustralia
| | - Simon A. Joosten
- School of Clinical SciencesMonash UniversityMelbourneVictoriaAustralia
- Monash Lung, Sleep, Allergy and ImmunologyMonash HealthMelbourneVictoriaAustralia
- Monash Partners – EpworthMelbourneVictoriaAustralia
| | - Dwayne L. Mann
- Department of Physiology, School of Biomedical Sciences and Biomedical Discovery InstituteMonash UniversityMelbourneVictoriaAustralia
- School of Information Technology and Electrical EngineeringThe University of QueenslandBrisbaneQueenslandAustralia
| | - Ai‐Ming Wong
- Monash Lung, Sleep, Allergy and ImmunologyMonash HealthMelbourneVictoriaAustralia
- Monash Partners – EpworthMelbourneVictoriaAustralia
| | - Tim Cheung
- Monash Partners – EpworthMelbourneVictoriaAustralia
| | - Mulki Adam
- Department of Physiology, School of Biomedical Sciences and Biomedical Discovery InstituteMonash UniversityMelbourneVictoriaAustralia
| | - Caroline J. Beatty
- Department of Physiology, School of Biomedical Sciences and Biomedical Discovery InstituteMonash UniversityMelbourneVictoriaAustralia
- Turner Institute for Brain and Mental HealthMonash UniversityMelbourneVictoriaAustralia
| | - Garun S. Hamilton
- School of Clinical SciencesMonash UniversityMelbourneVictoriaAustralia
- Monash Lung, Sleep, Allergy and ImmunologyMonash HealthMelbourneVictoriaAustralia
- Monash Partners – EpworthMelbourneVictoriaAustralia
| | - Bradley A. Edwards
- Department of Physiology, School of Biomedical Sciences and Biomedical Discovery InstituteMonash UniversityMelbourneVictoriaAustralia
- Turner Institute for Brain and Mental HealthMonash UniversityMelbourneVictoriaAustralia
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Randerath W, de Lange J, Hedner J, Ho JPT, Marklund M, Schiza S, Steier J, Verbraecken J. Current and Novel Treatment Options for OSA. ERJ Open Res 2022; 8:00126-2022. [PMID: 35769417 PMCID: PMC9234427 DOI: 10.1183/23120541.00126-2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Accepted: 04/24/2022] [Indexed: 12/03/2022] Open
Abstract
Obstructive sleep apnoea is a challenging medical problem due to its prevalence, its impact on quality of life and performance in school and professionally, the implications for risk of accidents, and comorbidities and mortality. Current research has carved out a broad spectrum of clinical phenotypes and defined major pathophysiological components. These findings point to the concept of personalised therapy, oriented on both the distinct clinical presentation and the most relevant pathophysiology in the individual patient. This leads to questions of whether sufficient therapeutic options other than positive airway pressure (PAP) alone are available, for which patients they may be useful, if there are specific indications for single or combined treatment, and whether there is solid scientific evidence for recommendations. This review describes our knowledge on PAP and non-PAP therapies to address upper airway collapsibility, muscle responsiveness, arousability and respiratory drive. The spectrum is broad and heterogeneous, including technical and pharmaceutical options already in clinical use or at an advanced experimental stage. Although there is an obvious need for more research on single or combined therapies, the available data demonstrate the variety of effective options, which should replace the unidirectional focus on PAP therapy. The analysis of individual pathophysiological composition opens new directions towards personalised treatment of OSA, focusing not only on pharyngeal dilation, but also on technical or pharmaceutical interventions on muscle function or breathing regulationhttps://bit.ly/3sayhkd
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Villedieu E, Robinson W, Shales C. Suspected Obstructive Sleep Apnea Successfully Treated with Ondansetron in a Pug. J Am Anim Hosp Assoc 2022; 58:152-155. [PMID: 35576395 DOI: 10.5326/jaaha-ms-7190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/08/2021] [Indexed: 11/11/2022]
Abstract
Obstructive sleep apnea (OSA) has been uncommonly reported in dogs and is often associated with brachycephalic obstructive airway syndrome (BOAS). OSA independent from BOAS has been rarely reported. Treatment of OSA with ondansetron has only been reported in one dog and has not been reported in a breed commonly affected by BOAS. Here, we report the case of a pug with episodes of OSA despite appropriate treatment of BOAS. Administration of ondansetron led to a rapid and near-complete resolution of the clinical signs, with a follow-up of 3 mo. OSA independent of BOAS should be considered as a differential diagnosis in dogs that present for sleep-disordered breathing without exercise intolerance after appropriate treatment for BOAS. Use of certain serotonin antagonists may be useful as a treatment option for these cases.
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Affiliation(s)
- Erika Villedieu
- From the Department of Soft Tissue Surgery, Willows Veterinary Centre and Referral Service, Solihull, United Kingdom
| | - William Robinson
- From the Department of Soft Tissue Surgery, Willows Veterinary Centre and Referral Service, Solihull, United Kingdom
| | - Chris Shales
- From the Department of Soft Tissue Surgery, Willows Veterinary Centre and Referral Service, Solihull, United Kingdom
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Stavrou VT, Astara K, Tourlakopoulos KN, Papayianni E, Boutlas S, Vavougios GD, Daniil Z, Gourgoulianis KI. Obstructive Sleep Apnea Syndrome: The Effect of Acute and Chronic Responses of Exercise. Front Med (Lausanne) 2022; 8:806924. [PMID: 35004785 PMCID: PMC8738168 DOI: 10.3389/fmed.2021.806924] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Accepted: 12/07/2021] [Indexed: 11/22/2022] Open
Abstract
Obstructive Sleep Apnea Syndrome (OSAS) is a sleep disorder with high prevalence in general population, but alarmingly low in clinicians' differential diagnosis. We reviewed the literature on PubMed and Scopus from June 1980–2021 in order to describe the altered systematic pathophysiologic mechanisms in OSAS patients as well as to propose an exercise program for these patients. Exercise prevents a dysregulation of both daytime and nighttime cardiovascular autonomic function, reduces body weight, halts the onset and progress of insulin resistance, while it ameliorates excessive daytime sleepiness, cognitive decline, and mood disturbances, contributing to an overall greater sleep quality and quality of life.
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Affiliation(s)
- Vasileios T Stavrou
- Laboratory of Cardio-Pulmonary Testing and Pulmonary Rehabilitation, Department of Respiratory Medicine, Faculty of Medicine, University of Thessaly, Larissa, Greece
| | - Kyriaki Astara
- Laboratory of Cardio-Pulmonary Testing and Pulmonary Rehabilitation, Department of Respiratory Medicine, Faculty of Medicine, University of Thessaly, Larissa, Greece
| | - Konstantinos N Tourlakopoulos
- Laboratory of Cardio-Pulmonary Testing and Pulmonary Rehabilitation, Department of Respiratory Medicine, Faculty of Medicine, University of Thessaly, Larissa, Greece
| | - Eirini Papayianni
- Laboratory of Cardio-Pulmonary Testing and Pulmonary Rehabilitation, Department of Respiratory Medicine, Faculty of Medicine, University of Thessaly, Larissa, Greece
| | - Stylianos Boutlas
- Laboratory of Cardio-Pulmonary Testing and Pulmonary Rehabilitation, Department of Respiratory Medicine, Faculty of Medicine, University of Thessaly, Larissa, Greece
| | - George D Vavougios
- Laboratory of Cardio-Pulmonary Testing and Pulmonary Rehabilitation, Department of Respiratory Medicine, Faculty of Medicine, University of Thessaly, Larissa, Greece
| | - Zoe Daniil
- Laboratory of Cardio-Pulmonary Testing and Pulmonary Rehabilitation, Department of Respiratory Medicine, Faculty of Medicine, University of Thessaly, Larissa, Greece
| | - Konstantinos I Gourgoulianis
- Laboratory of Cardio-Pulmonary Testing and Pulmonary Rehabilitation, Department of Respiratory Medicine, Faculty of Medicine, University of Thessaly, Larissa, Greece
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Daily acute intermittent hypoxia enhances serotonergic innervation of hypoglossal motor nuclei in rats with and without cervical spinal injury. Exp Neurol 2022; 347:113903. [PMID: 34699788 PMCID: PMC8848979 DOI: 10.1016/j.expneurol.2021.113903] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2021] [Revised: 10/17/2021] [Accepted: 10/20/2021] [Indexed: 01/03/2023]
Abstract
Intermittent hypoxia elicits protocol-dependent effects on hypoglossal (XII) motor plasticity. Whereas low-dose, acute intermittent hypoxia (AIH) elicits serotonin-dependent plasticity in XII motor neurons, high-dose, chronic intermittent hypoxia (CIH) elicits neuroinflammation that undermines AIH-induced plasticity. Preconditioning with repeated AIH and mild CIH enhance AIH-induced XII motor plasticity. Since intermittent hypoxia pre-conditioning could enhance serotonin-dependent XII motor plasticity by increasing serotonergic innervation density of the XII motor nuclei, we tested the hypothesis that 3 distinct intermittent hypoxia protocols commonly studied to elicit plasticity (AIH) or simulate aspects of sleep apnea (CIH) differentially affect XII serotonergic innervation. Sleep apnea and associated CIH are common in people with cervical spinal injuries and, since repetitive AIH is emerging as a promising therapeutic strategy to improve respiratory and non-respiratory motor function after spinal injury, we also tested the hypotheses that XII serotonergic innervation is increased by repetitive AIH and/or CIH in rats with cervical C2 hemisections (C2Hx). Serotonergic innervation was assessed via immunofluorescence in male Sprague Dawley rats, with and without C2Hx (beginning 8 weeks post-injury) exposed to 28 days of: 1) normoxia; 2) daily AIH (10, 5-min 10.5% O2 episodes per day; 5-min normoxic intervals); 3) mild CIH (5-min 10.5% O2 episodes; 5-min intervals; 8 h/day); and 4) moderate CIH (2-min 10.5% O2 episodes; 2-min intervals; 8 h/day). Daily AIH, but neither CIH protocol, increased the area of serotonergic immunolabeling in the XII motor nuclei in both intact and injured rats. C2Hx per se had no effect on XII serotonergic innervation density. Thus, daily AIH may increases XII serotonergic innervation and function, enhancing the capacity for serotonin-dependent, AIH-induced plasticity in upper airway motor neurons. Such effects may preserve upper airway patency and/or swallowing ability in people with cervical spinal cord injuries and other clinical disorders that compromise breathing and airway defense.
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Short term impact of antidepressants on the cardinal symptoms of depression in OSA patients with comorbid MDD who are APAP-adherent: A retrospective study in a veteran population. JOURNAL OF AFFECTIVE DISORDERS REPORTS 2021. [DOI: 10.1016/j.jadr.2021.100236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Serum Serotonin as a Biomarker of the Efficacy of PAP-Therapy in Sleep Apnea Syndrome. Bull Exp Biol Med 2021; 171:713-715. [PMID: 34705172 DOI: 10.1007/s10517-021-05301-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Indexed: 10/20/2022]
Abstract
Serum serotonin levels were determined by HPLC in 30 patients with diagnosed obstructive sleep apnea syndrome before and after 3-month course of PAP-therapy and in 14 subjects without obstructive sleep apnea symptoms. It was found that elimination of hypoxic conditions was associated with an increase in serotonin level. The results demonstrate the effectiveness of PAP-therapy during sleep and allow assessing the role of serotonin as a potential biomarker of intermittent hypoxia during sleep.
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Sleep Apnea and Serum Serotonin Level Pre- and Post-PAP Therapy: A Preliminary Study. Neurol Ther 2021; 10:1095-1102. [PMID: 34669160 PMCID: PMC8571426 DOI: 10.1007/s40120-021-00290-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Accepted: 10/05/2021] [Indexed: 12/04/2022] Open
Abstract
Introduction The high prevalence of obstructive sleep apnea (OSA), which impairs quality of life for numerous patients and leads to various OSA complications, has contributed to the continued interest in this disorder. The role of serotonin (5-HT) in many physiological processes, studies on its connection with the circadian system, and relationship to changes in sleep architecture are insufficient to assess the interaction of this neurotransmitter with nocturnal hypoxia. The aim of this study was to determine changes in sleep patterns and serum serotonin levels before and after positive airway pressure (PAP) therapy in patients with OSA. Methods The study involved 30 OSA patients (27 men and 3 women) who were treated with PAP for 3 months. Polysomnography using the GRASS TELEFACTOR (USA) and blood collection were conducted before and after PAP courses. Determination of serum serotonin was performed by high-performance liquid chromatography (HPLC). PAP therapy was performed using an automatic Prisma 20A (Germany) continuous positive airway pressure (CPAP) device. Results The use of PAP for 3 months revealed a significant improvement as measured by sleep data and serotonin levels (before: apnea index [AI] 17.2 eV/h, after: 2.4 eV/h p = 0.001; SpO2 < 90% − 45.7 min vs. 6.2 min p = 0.001; serotonin 20.3 ng/mL vs. 26.03 ng/mL p = 0.036]. Conclusion Our results demonstrate an improvement in sleep patterns. There was an increase in serum serotonin levels in OSA patients following PAP therapy, which could be an effect of intermittent hypoxia decline, and could be used as criteria for the effectiveness of PAP and an improvement in sleep quality.
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Prowting J, Maresh S, Vaughan S, Kruppe E, Alsabri B, Badr MS, Sankari A. Mirtazapine reduces susceptibility to hypocapnic central sleep apnea in males with sleep-disordered breathing: a pilot study. J Appl Physiol (1985) 2021; 131:414-423. [PMID: 34080920 PMCID: PMC8325612 DOI: 10.1152/japplphysiol.00838.2020] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
Studies in humans and animal models with spinal cord injury (SCI) have demonstrated that medications targeting serotonin receptors may decrease the susceptibility to central sleep-disordered breathing (SDB). We hypothesized that mirtazapine would decrease the propensity to develop hypocapnic central sleep apnea (CSA) during sleep. We performed a single-blind pilot study on a total of 10 men with SDB (7 with chronic SCI and 3 noninjured) aged 52.0 ± 11.2 yr. Participants were randomly assigned to either mirtazapine (15 mg at bedtime) or a placebo for at least 1 wk, followed by a 7-day washout period before crossing over to the other intervention. Split-night studies included polysomnography and induction of hypocapnic CSA using a noninvasive ventilation (NIV) protocol. The primary outcome was CO2 reserve, defined as the difference between eupneic and end of NIV end-tidal CO2 ([Formula: see text]) preceding induced hypocapneic CSA. Secondary outcomes included controller gain (CG), other ventilatory parameters, and SDB severity. CG was defined as the ratio of change in minute ventilation (V̇e) between control and hypopnea to the change in CO2 during sleep. CO2 reserve was significantly widened on mirtazapine than placebo (-3.8 ± 1.2 vs. -2.0 ± 1.5 mmHg; P = 0.015). CG was significantly decreased on mirtazapine compared with placebo [2.2 ± 0.7 vs. 3.5 ± 1.9 L/(mmHg × min); P = 0.023]. There were no significant differences for other ventilatory parameters assessed or SDB severity between mirtazapine and placebo trials. These findings suggest that the administration of mirtazapine can decrease the susceptibility to central apnea by reducing chemosensitivity and increasing CO2 reserve; however, considering the lack of changes in apnea-hypopnea index (AHI), further research is required to understand the significance of this finding.NEW & NOTEWORTHY To our knowledge, this research study is novel as it is the first study in humans assessing the effect of mirtazapine on CO2 reserve and chemosensitivity in individuals with severe sleep-disordered breathing. This is also the first study to determine the potential therapeutic effects of mirtazapine on sleep parameters in individuals with a spinal cord injury.
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Affiliation(s)
- Joel Prowting
- 1Sleep Research Laboratory, John D. Dingell Veterans Affairs Medical Center, Detroit, Michigan,2Wayne State University School of Medicine, Detroit, Michigan
| | - Scott Maresh
- 1Sleep Research Laboratory, John D. Dingell Veterans Affairs Medical Center, Detroit, Michigan,2Wayne State University School of Medicine, Detroit, Michigan
| | - Sarah Vaughan
- 1Sleep Research Laboratory, John D. Dingell Veterans Affairs Medical Center, Detroit, Michigan,2Wayne State University School of Medicine, Detroit, Michigan
| | - Elizabeth Kruppe
- 1Sleep Research Laboratory, John D. Dingell Veterans Affairs Medical Center, Detroit, Michigan,2Wayne State University School of Medicine, Detroit, Michigan
| | - Bander Alsabri
- 1Sleep Research Laboratory, John D. Dingell Veterans Affairs Medical Center, Detroit, Michigan,2Wayne State University School of Medicine, Detroit, Michigan
| | - M. Safwan Badr
- 1Sleep Research Laboratory, John D. Dingell Veterans Affairs Medical Center, Detroit, Michigan,2Wayne State University School of Medicine, Detroit, Michigan
| | - Abdulghani Sankari
- 1Sleep Research Laboratory, John D. Dingell Veterans Affairs Medical Center, Detroit, Michigan,2Wayne State University School of Medicine, Detroit, Michigan,3Ascension Providence Hospital, Southfield, Michigan
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14
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Scholes M, Jensen E, Meier M, Friedman N. Effect of adenotonsillectomy in children with obstructive sleep apnea and major psychiatric disorders on obstructive apnea-hypopnea index and Epworth Sleepiness Scale scores. J Clin Sleep Med 2021; 17:685-689. [PMID: 33206042 DOI: 10.5664/jcsm.9012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
STUDY OBJECTIVES This study evaluates the effectiveness of adenotonsillectomy in the treatment of obstructive sleep apnea in children with major psychiatric disorders as measured by polysomnography and the Epworth Sleepiness Scale (ESS) at a tertiary children's hospital. Adults with major psychiatric disorders often have higher rates of obstructive sleep apnea and decreased response to treatment. The goal was to determine if children with serious mental illness had outcomes similar to their adult counterparts. METHODS A retrospective chart review was undertaken to identify children with obstructive sleep apnea and major psychiatric disorders who underwent adenotonsillectomy as part of their treatment for obstructive sleep apnea and had undergone preoperative and postoperative polysomnography as well as ESS. A multivariable model was run for each of the postoperative outcomes (ESS, obstructive apnea-hypopnea index, or body mass index percentile), adjusting for their respective preoperative value, age, and group. RESULTS There were 34 patients who qualified for this study and who were matched with 66 controls. There was no significant difference between the 2 groups in terms of change in ESS, obstructive apnea-hypopnea index, or body mass index percentile, both before and after adjusting for age. The only significant findings were that preoperative ESS and body mass index percentile were predictive of postoperative ESS and body mass index percentile for both groups. CONCLUSIONS Children with psychiatric disorders in our institution respond to surgical management of obstructive sleep apnea similar to pediatric controls without mental illness despite comorbidities and central-acting medications that may alter sleep.
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Affiliation(s)
- Melissa Scholes
- Department of Otolaryngology-Head and Neck Surgery, University of Colorado School of Medicine, Aurora, Colorado.,Department of Pediatric Otolaryngology, Children's Hospital Colorado, Aurora, Colorado
| | - Emily Jensen
- Department of Otolaryngology-Head and Neck Surgery, University of Colorado School of Medicine, Aurora, Colorado.,Department of Pediatric Otolaryngology, Children's Hospital Colorado, Aurora, Colorado
| | - Maxene Meier
- Center for Research in Outcomes for Children's Surgery, Center for Children's Surgery, University of Colorado School of Medicine, Aurora, Colorado
| | - Norman Friedman
- Department of Otolaryngology-Head and Neck Surgery, University of Colorado School of Medicine, Aurora, Colorado.,Department of Pediatric Otolaryngology, Children's Hospital Colorado, Aurora, Colorado
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15
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Robillard R, Saad M, Ray LB, BuJáki B, Douglass A, Lee EK, Soucy L, Spitale N, De Koninck J, Kendzerska T. Selective serotonin reuptake inhibitor use is associated with worse sleep-related breathing disturbances in individuals with depressive disorders and sleep complaints: a retrospective study. J Clin Sleep Med 2021; 17:505-513. [PMID: 33118928 DOI: 10.5664/jcsm.8942] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
STUDY OBJECTIVES The effects of serotonergic agents on respiration neuromodulation may vary according to differences in the serotonin system, such as those linked to depression. This study investigated how sleep-related respiratory disturbances relate to depression and the use of medications commonly prescribed for depression. METHODS Retrospective polysomnography was collated for all 363 individuals who met selection criteria out of 2,528 consecutive individuals referred to a specialized sleep clinic (Ottawa, Canada) between 2006 and 2016. The apnea-hypopnea index (AHI), oxygen saturation nadir, and oxygen desaturation index during REM and NREM sleep were analyzed using mixed analyses of covariance comparing 3 main groups: (1) medicated individuals with depressive disorders (antidepressant group; subdivided into the selective serotonin reuptake inhibitor and norepinephrine-dopamine reuptake inhibitor subgroups), (2) non-medicated individuals with depressive disorders (non-medicated group), and (3) mentally healthy control patients (control group). RESULTS Individuals with depressive disorders (on antidepressants or not) had significantly higher AHIs compared to control patients (both P ≤ .007). The antidepressant group had a lower NREM sleep oxygen saturation nadir and a higher NREM sleep oxygen desaturation index than the control and non-medicated groups (all P ≤ .009). Within individuals with depressive disorders, independent of depression severity, the selective serotonin reuptake inhibitor group had a lower oxygen saturation nadir and a higher oxygen desaturation index during NREM sleep than the norepinephrine-dopamine reuptake inhibitor (both P ≤ .045) and non-medicated groups (both P < .001) and a higher NREM sleep AHI than the non-medicated group (P = .014). CONCLUSIONS These findings suggest that the use of selective serotonin reuptake inhibitors may be associated with impaired breathing and worse nocturnal oxygen saturation in individuals with depressive disorders and sleep complaints, but this needs to be confirmed by prospective studies.
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Affiliation(s)
- Rébecca Robillard
- Sleep Research Unit, The Royal's Institute of Mental Health Research, Ottawa, Canada.,School of Psychology, University of Ottawa, Ottawa, Canada
| | - Mysa Saad
- Sleep Research Unit, The Royal's Institute of Mental Health Research, Ottawa, Canada.,Faculty of Medicine, University of Ottawa, Ottawa, Canada
| | - Laura B Ray
- Sleep Research Unit, The Royal's Institute of Mental Health Research, Ottawa, Canada
| | - Brad BuJáki
- Sleep Research Unit, The Royal's Institute of Mental Health Research, Ottawa, Canada.,Sleep Disorders Clinic, Royal Ottawa Mental Health Centre, Ottawa, Canada
| | - Alan Douglass
- Sleep Research Unit, The Royal's Institute of Mental Health Research, Ottawa, Canada.,Sleep Disorders Clinic, Royal Ottawa Mental Health Centre, Ottawa, Canada.,Department of Psychiatry, University of Ottawa, Ottawa, Canada
| | - Elliott K Lee
- Sleep Research Unit, The Royal's Institute of Mental Health Research, Ottawa, Canada.,Sleep Disorders Clinic, Royal Ottawa Mental Health Centre, Ottawa, Canada.,Department of Psychiatry, University of Ottawa, Ottawa, Canada
| | - Louis Soucy
- Sleep Disorders Clinic, Royal Ottawa Mental Health Centre, Ottawa, Canada.,Department of Psychiatry, University of Ottawa, Ottawa, Canada
| | - Naomi Spitale
- Sleep Research Unit, The Royal's Institute of Mental Health Research, Ottawa, Canada.,Sleep Disorders Clinic, Royal Ottawa Mental Health Centre, Ottawa, Canada
| | - Joseph De Koninck
- Sleep Research Unit, The Royal's Institute of Mental Health Research, Ottawa, Canada.,School of Psychology, University of Ottawa, Ottawa, Canada
| | - Tetyana Kendzerska
- Faculty of Medicine, University of Ottawa, Ottawa, Canada.,The Ottawa Hospital Research Institute, Ottawa, Canada
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16
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Chen CY, Chen CL, Yu CC. Trazodone improves obstructive sleep apnea after ischemic stroke: a randomized, double-blind, placebo-controlled, crossover pilot study. J Neurol 2021; 268:2951-2960. [PMID: 33625584 DOI: 10.1007/s00415-021-10480-2] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2020] [Revised: 02/15/2021] [Accepted: 02/16/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Low arousal threshold plays a part in the pathogenesis of obstructive sleep apnea (OSA) and may be improved by sedatives. Sedative antidepressants are frequently prescribed for stroke patients due to their high prevalence of insomnia and depression. However, the effect of sedative antidepressants on the severity of OSA in stroke patients has not been studied well. METHODS In a double-blinded randomized crossover pilot study, 22 post-acute ischemic stroke patients (mean age, 61.7 ± 10.6 y) with OSA received 100 mg of trazodone or a placebo just before polysomnography, with approximately 1 week between measures. The study also measured baseline heart rate variability and 24-h ambulatory blood pressure. RESULTS Administration of trazodone significantly increased the percentage time of slow-wave sleep (31.5 ± 13.2 vs. 18.4 ± 8.7%; P < 0.001) and improved almost all the parameters of OSA severity, including the apnea-hypopnea index (AHI, 25.4 ± 15.4 vs. 39.1 ± 18.4 events/h; P < 0.001), the respiratory arousal index (9.8 (5.8-11.95) vs. 14.1 (11.3-18.7) events/h; P < 0.001), and the minimum oxygen saturation (80.2 ± 9.1 vs. 77.1 ± 9.6%; P = 0.016). Responders to therapy (AHI reduced by > 50%; n = 7/22) had predominant OSA during rapid-eye-movement sleep and decreased sympathetic tone, as reflected in significantly lower mean blood pressure, diastolic blood pressure, and normalized low-frequency power. CONCLUSIONS Obstructive sleep apnea with comorbid ischemic stroke may be a distinctive phenotype which responds quite well to trazodone, decreasing OSA severity without increasing nocturnal hypoxia. TRIAL REGISTRATION Clinicaltrials.gov: NCT04162743, 2019/11/10.
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Affiliation(s)
- Chung-Yao Chen
- Department of Physical Medicine and Rehabilitation, Chang Gung Memorial Hospital, Keelung, Taiwan. .,School of Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan.
| | - Chia-Ling Chen
- Department of Physical Medicine and Rehabilitation, Chang Gung Memorial Hospital, Linkou, Taiwan.,Graduate Institute of Early Intervention, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Chung-Chieh Yu
- School of Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan.,Division of Pulmonary Critical Care and Sleep Medicine, Department of Internal Medicine, Chang Gung Memorial Hospital, Keelung, Taiwan
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17
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Kim LJ, Freire C, Fleury Curado T, Jun JC, Polotsky VY. The Role of Animal Models in Developing Pharmacotherapy for Obstructive Sleep Apnea. J Clin Med 2019; 8:jcm8122049. [PMID: 31766589 PMCID: PMC6947279 DOI: 10.3390/jcm8122049] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Revised: 11/12/2019] [Accepted: 11/19/2019] [Indexed: 12/17/2022] Open
Abstract
Obstructive sleep apnea (OSA) is a highly prevalent disease characterized by recurrent closure of the upper airway during sleep. It has a complex pathophysiology involving four main phenotypes. An abnormal upper airway anatomy is the key factor that predisposes to sleep-related collapse of the pharynx, but it may not be sufficient for OSA development. Non-anatomical traits, including (1) a compromised neuromuscular response of the upper airway to obstruction, (2) an unstable respiratory control (high loop gain), and (3) a low arousal threshold, predict the development of OSA in association with anatomical abnormalities. Current therapies for OSA, such as continuous positive airway pressure (CPAP) and oral appliances, have poor adherence or variable efficacy among patients. The search for novel therapeutic approaches for OSA, including pharmacological agents, has been pursued over the past years. New insights into OSA pharmacotherapy have been provided by preclinical studies, which highlight the importance of appropriate use of animal models of OSA, their applicability, and limitations. In the present review, we discuss potential pharmacological targets for OSA discovered using animal models.
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18
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Targeting Endotypic Traits with Medications for the Pharmacological Treatment of Obstructive Sleep Apnea. A Review of the Current Literature. J Clin Med 2019; 8:jcm8111846. [PMID: 31684047 PMCID: PMC6912255 DOI: 10.3390/jcm8111846] [Citation(s) in RCA: 51] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2019] [Revised: 10/29/2019] [Accepted: 10/30/2019] [Indexed: 12/28/2022] Open
Abstract
Obstructive sleep apnea (OSA) is a highly prevalent condition with few therapeutic options. To date there is no approved pharmacotherapy for this disorder, but several attempts have been made in the past and are currently ongoing to find one. The recent identification of multiple endotypes underlying this disorder has oriented the pharmacological research towards tailored therapies targeting specific pathophysiological traits that contribute differently to cause OSA in each patient. In this review we retrospectively analyze the literature on OSA pharmacotherapy dividing the medications tested on the basis of the four main endotypes: anatomy, upper airway muscle activity, arousal threshold and ventilatory instability (loop gain). We show how recently introduced drugs for weight loss that modify upper airway anatomy may play an important role in the management of OSA in the near future, and promising results have been obtained with drugs that increase upper airway muscle activity during sleep and reduce loop gain. The lack of a medication that can effectively increase the arousal threshold makes this strategy less encouraging, although recent studies have shown that the use of certain sedatives do not worsen OSA severity and could actually improve patients' sleep quality.
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19
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Obstructive Sleep Apnea: Emerging Treatments Targeting the Genioglossus Muscle. J Clin Med 2019; 8:jcm8101754. [PMID: 31652594 PMCID: PMC6832267 DOI: 10.3390/jcm8101754] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Revised: 10/11/2019] [Accepted: 10/18/2019] [Indexed: 02/06/2023] Open
Abstract
Obstructive sleep apnea (OSA) is characterized by repetitive episodes of upper airway obstruction caused by a loss of upper airway dilator muscle tone during sleep and an inadequate compensatory response by these muscles in the context of an anatomically compromised airway. The genioglossus (GG) is the main upper airway dilator muscle. Currently, continuous positive airway pressure is the first-line treatment for OSA. Nevertheless, problems related to poor adherence have been described in some groups of patients. In recent years, new OSA treatment strategies have been developed to improve GG function. (A) Hypoglossal nerve electrical stimulation leads to significant improvements in objective (apnea-hypopnea index, or AHI) and subjective measurements of OSA severity, but its invasive nature limits its application. (B) A recently introduced combination of drugs administered orally before bedtime reduces AHI and improves the responsiveness of the GG. (C) Finally, myofunctional therapy also decreases AHI, and it might be considered in combination with other treatments. Our objective is to review these therapies in order to advance current understanding of the prospects for alternative OSA treatments.
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20
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Fleury Curado T, Berger S, Polotsky VY. Pharmacotherapy of Obstructive Sleep Apnea: Is Salvation Just Around a Corner? Am J Respir Crit Care Med 2019; 199:1186-1187. [PMID: 30521761 PMCID: PMC6519854 DOI: 10.1164/rccm.201811-2135ed] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Affiliation(s)
| | - Slava Berger
- 1 Johns Hopkins University School of Medicine Baltimore, Maryland
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21
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Kopke MA, Wightman P, Ruaux CG. Obstructive sleep apnea in a Chihuahua successfully managed with ondansetron. Clin Case Rep 2019; 7:872-876. [PMID: 31110706 PMCID: PMC6510004 DOI: 10.1002/ccr3.2110] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2019] [Accepted: 03/02/2019] [Indexed: 12/19/2022] Open
Abstract
While the persistence of clinical signs related to brachycephalic obstructive airway syndrome, particularly sleep-disordered breathing patterns following appropriate surgical management is likely to be relatively rare, this potential sequela needs to be considered, along with being aware of possible medical management options such as serotonin antagonists.
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Affiliation(s)
- Matthew A. Kopke
- School of Veterinary ScienceMassey University Veterinary Teaching HospitalPalmerston NorthNew Zealand
| | - Paul Wightman
- School of Veterinary ScienceMassey University Veterinary Teaching HospitalPalmerston NorthNew Zealand
| | - Craig G. Ruaux
- School of Veterinary ScienceMassey University Veterinary Teaching HospitalPalmerston NorthNew Zealand
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22
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Serotonin Reuptake Inhibitors in Obstructive Sleep Apnea: Associations in People with and without Epilepsy. Neurol Res Int 2018; 2018:7247605. [PMID: 30245877 PMCID: PMC6136557 DOI: 10.1155/2018/7247605] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2018] [Revised: 07/09/2018] [Accepted: 07/26/2018] [Indexed: 11/17/2022] Open
Abstract
Purpose Positive airway pressure remains the gold-standard treatment for OSA, but many are intolerant. The neurotransmitter serotonin is involved in respiratory control. Evidence exists for SRIs in reducing OSA severity in the general population and ictal hypoxemia and seizure-induced respiratory arrest in people with epilepsy (PWE). However, the association between SRIs and OSA severity has not been studied in populations consisting of both groups. This study aims to determine if SRIs are associated with OSA severity in both PWE and people without epilepsy (PWO) and whether differences exist between the two groups. Methods A retrospective study of adults with OSA was conducted. Subjects were categorized as PWE or PWO and for the use (+SRI) or absence (-SRI) of an SRI. The primary outcome was OSA severity relative to SRI status. OSA severity as a function of SRI status was also compared between PWE and PWO and within the PWE and PWO cohorts. Oxygen saturation nadir was a secondary outcome measure. Statistical adjustment of pertinent characteristics was performed. Results There were 125 subjects (57 PWE, 68 PWO, 80 –SRI, and 45 +SRI). +SRI was associated with reduced odds of severe compared to moderate OSA, in unadjusted and adjusted analysis. Compared to PWO, PWE demonstrated a more robust association between OSA severity and +SRI. When analyzed as separate cohorts, only PWE demonstrated reduced OSA severity, with adjustment for age (OR:0.140, CI:0.021-1.116, and p=0.042). Oxygen saturation nadir was not significant in any model. Conclusions SRIs represent a potential treatment option for OSA and may demonstrate a more robust association with reduced OSA severity in PWE compared to PWO.
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24
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Fukui A, Nakayama M, Sakamoto N, Arima S, Sato S, Suzuki M, Murakami S. Relation between globus pharyngeus and OSA in patients examined simultaneously by PSG and pH monitor: A cross sectional study. Auris Nasus Larynx 2018; 45:1033-1040. [PMID: 29544872 DOI: 10.1016/j.anl.2018.01.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2017] [Revised: 01/16/2018] [Accepted: 01/23/2018] [Indexed: 10/17/2022]
Abstract
OBJECTIVE This was a first cross-sectional single-center study to research the relation between globus pharyngeus, OSA and GERD. Since previous clinical studies have demonstrated a relationship between globus phayrngeus and GERD, however, no reported study on the relation between globus pharyngeus, sleep disorders including OSA, and GERD. METHODS Seventeen patients underwent general and otorhinolaryngological examinations and responded to several questionnaires (ESS, PSQI, HADS, and Globus pharyngeus VAS score) at their first visit, and underwent a gastroesophageal test for 24-h pH monitoring and in-laboratory PSG one to two months later. RESULTS No significant differences were seen in ESS, PSQI, or HADS scores between the groups. The acid exposure time was not significantly different among the groups. The percentage of esophageal reflux time was higher than the percentage of laryngopharyngeal reflux time through the total time as well as the supine period. This indicated that GERD occurred more frequently than laryngopharyngeal reflux. The entire results showed concurrent OSA in 10 cases (59%) and concurrent GERD in 7 cases (41%). The cases with OSA were treated by CPAP or oral appliance, and those treatments were effective for globus pharyngeus. CONCLUSION Although the relation between OSA and globus phayngeus is still controversial, these findings suggest that OSA may be a previously undetected cause of globus pharyngeus. By improving OSA, it may offer an additional option of treatment for those globus pharyngeus cases combined with OSA.
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Affiliation(s)
- Ayako Fukui
- Good Sleep Center & Department of Otolaryngology, Nagoya City University, Nagoya, Japan
| | - Meiho Nakayama
- Good Sleep Center & Department of Otolaryngology, Nagoya City University, Nagoya, Japan.
| | - Naoko Sakamoto
- Department of Epidemiologic Research, Toho University, Tokyo, Japan
| | - Sachie Arima
- Good Sleep Center & Department of Otolaryngology, Nagoya City University, Nagoya, Japan
| | - Shintaro Sato
- Good Sleep Center & Department of Otolaryngology, Nagoya City University, Nagoya, Japan
| | - Motohiko Suzuki
- Department of Otolaryngology, Nagoya City University, Nagoya, Japan
| | - Shingo Murakami
- Department of Otolaryngology, Nagoya City University, Nagoya, Japan
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25
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An update on preoperative assessment and preparation of surgical patients with obstructive sleep apnea. Curr Opin Anaesthesiol 2018; 31:89-95. [DOI: 10.1097/aco.0000000000000539] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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26
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Rezaeitalab F, Mokhber N, Ravanshad Y, Saberi S, Rezaeetalab F. Different polysomnographic patterns in military veterans with obstructive sleep apnea in those with and without post-traumatic stress disorder. Sleep Breath 2018; 22:17-22. [PMID: 29302923 DOI: 10.1007/s11325-017-1596-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2017] [Revised: 10/21/2017] [Accepted: 11/15/2017] [Indexed: 12/30/2022]
Abstract
INTRODUCTION AND OBJECTIVES Obstructive sleep apnea (OSA) is a prevalent disorder among military veterans. The goal of this study is to compare the polysomnographic patterns of OSA in military veterans who have a history of post-traumatic stress disorder (PTSD) with those of veterans who have not PTSD. MATERIALS AND METHODS Seventy-two Iranian military male veterans were classified into two groups: those with PTSD (40 cases) and those without PTSD (32 cases). Each participant was diagnosed with OSA using an overnight polysomnography, during which sleep-related parameters such as sleep efficiency (SE) and apnea-related events were detected. The body mass index (BMI) and Epworth Sleepiness Scale (ESS) were also assessed. RESULTS For the PTSD group, mean age was 53.83 ± 7.3 years, elapsed time since they participated in war was 28.3 ± 3.4 years, apnea-hypopnea index (AHI) was 41.2 ± 27, SE was 77.7 ± 17.55%, ESS was 7.93 ± 2.04, BMI was 26.5 ± 5.7, and PLM index was 12.725 ± 8.64. The above respective parameters for the non-PTSD group were 51.33 ± 5.9 years, 28.3 ± 3.4 years, 30.33 ± 14.7, 82.4 ± 15.65%, 10.08 ± 3.02, 31.5 ± 6.7, and 8.8 ± 3.54. The relationships of AHI with ESS and BMI were not significant in PTSD group. CONCLUSION OSA in military veterans suffering from PTSD presents more often with insomnia than obesity or increased daytime sleepiness. These findings are different from those typically seen in non-PTSD veterans with OSA.
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Affiliation(s)
- Fariborz Rezaeitalab
- Department of Neurology, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Naghmeh Mokhber
- Psychiatry and Behavioral Sciences Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Yalda Ravanshad
- Community Medicine, Clinical Research Unite, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Soheila Saberi
- Department of Pathology, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.,University of Sydney, Sydney, Australia
| | - Fariba Rezaeetalab
- Department of Pulmonology, Lung Disease Research Center, Mashhad University of Medical Sciences, Mashhad, Iran.
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Systems Biology Genetic Approach Identifies Serotonin Pathway as a Possible Target for Obstructive Sleep Apnea: Results from a Literature Search Review. SLEEP DISORDERS 2017; 2017:6768323. [PMID: 29057124 PMCID: PMC5625807 DOI: 10.1155/2017/6768323] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/30/2017] [Accepted: 06/14/2017] [Indexed: 12/25/2022]
Abstract
Rationale Overall validity of existing genetic biomarkers in the diagnosis of obstructive sleep apnea (OSA) remains unclear. The objective of this systematic genetic study is to identify “novel” biomarkers for OSA using systems biology approach. Methods Candidate genes for OSA were extracted from PubMed, MEDLINE, and Embase search engines and DisGeNET database. The gene ontology (GO) analyses and candidate genes prioritization were performed using Enrichr tool. Genes pertaining to the top 10 pathways were extracted and used for Ingenuity Pathway Analysis. Results In total, we have identified 153 genes. The top 10 pathways associated with OSA include (i) serotonin receptor interaction, (ii) pathways in cancer, (iii) AGE-RAGE signaling in diabetes, (iv) infectious diseases, (v) serotonergic synapse, (vi) inflammatory bowel disease, (vii) HIF-1 signaling pathway, (viii) PI3-AKT signaling pathway, (ix) regulation lipolysis in adipocytes, and (x) rheumatoid arthritis. After removing the overlapping genes, we have identified 23 candidate genes, out of which >30% of the genes were related to the genes involved in the serotonin pathway. Among these 4 serotonin receptors SLC6A4, HTR2C, HTR2A, and HTR1B were strongly associated with OSA. Conclusions This preliminary report identifies several potential candidate genes associated with OSA and also describes the possible regulatory mechanisms.
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Understanding Phenotypes of Obstructive Sleep Apnea: Applications in Anesthesia, Surgery, and Perioperative Medicine. Anesth Analg 2017; 124:179-191. [PMID: 27861433 DOI: 10.1213/ane.0000000000001546] [Citation(s) in RCA: 88] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Obstructive sleep apnea (OSA) is a prevalent sleep-disordered breathing with potential long-term major neurocognitive and cardiovascular sequelae. The pathophysiology of OSA varies between individuals and is composed of different underlying mechanisms. Several components including the upper airway anatomy, effectiveness of the upper airway dilator muscles such as the genioglossus, arousal threshold of the individual, and inherent stability of the respiratory control system determine the pathogenesis of OSA. Their recognition may have implications for the perioperative health care team. For example, OSA patients with a high arousal threshold are likely to be sensitive to sedatives and narcotics with a higher risk of respiratory arrest in the perioperative period. Supplemental oxygen therapy can help to stabilize breathing in OSA patients with inherent respiratory instability. Avoidance of supine position can minimize airway obstruction in patients with a predisposition to upper airway collapse in this posture. In this review, the clinically relevant endotypes and phenotypes of OSA are described. Continuous positive airway pressure (CPAP) therapy is the treatment of choice for most patients with OSA but tolerance and adherence can be a problem. Patient-centered individualized approaches to OSA management will be the focus of future research into developing potential treatment options that will help decrease the disease burden and improve treatment effectiveness.
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Shoib S, Malik JA, Masoodi S. Depression as a Manifestation of Obstructive Sleep Apnea. J Neurosci Rural Pract 2017; 8:346-351. [PMID: 28694611 PMCID: PMC5488552 DOI: 10.4103/jnrp.jnrp_462_16] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Obstructive sleep apnea (OSA) often results in a wide range of comorbid conditions, predominantly of the cardiovascular/respiratory, endocrine/metabolic, and neuropsychiatric symptoms. In view of the ambiguity of literature regarding the association between OSA and depression, we conducted this study to show any association between the two disorders. OBJECTIVE The aim of the study was to see the association between OSA and depression and to study the prevalence of OSA in patients suffering from depression. METHODS We performed polysomnography (PSG) studies of patients that were referred from various subspecialty clinics from July 2011 to August 2013. Psychiatric diagnosis was done using mini international neuropsychiatric interview plus scale. This was followed by application of Hamilton Depression Rating Scale (HAM-D). Standard methods of statistical analysis were used for data analysis. RESULTS Out of 182 patients who underwent PSG, 47 were suffering from depression with a mean age significantly more (P < 0.001) than that of other population (58.60 years vs. 53.60 years). In our 47 depressed patients, 44 (93.6%) had abnormal PSG. Based on apnea-hypopnea index score, 3 (6.8%) patients had mild, 18 (40.9%) had moderate, and 23 (52.3%) had severe OSA. The mean HAM-D score was significantly more in depression patients, (17. 35 ± 5.45) as compared to non depressive patents (8.64 ± 6.24) (P = 0.0001). CONCLUSION This study demonstrates significant overlap between the sleep apnea and depression. Health specialists need more information about screening for patients with OSA to ensure proper diagnosis and treatment of those with the condition. Most of the clinicians do not suspect this important comorbidity of depression in the beginning resulting in delayed diagnosis.
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Affiliation(s)
- Sheikh Shoib
- Department of Health, JK Health Services, Srinagar, Jammu and Kashmir, India
| | - Javid A. Malik
- Department of Pulmonary Medicine, SKIMS Medical College, Srinagar, Jammu and Kashmir, India
| | - Shariq Masoodi
- Department of Endocrinology, SKIMS, Srinagar, Jammu and Kashmir, India
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Kanamaru M. [Neurochemical aspects of obstructive sleep apnea syndrome - medullary serotonergic system]. Nihon Yakurigaku Zasshi 2017; 150:177-182. [PMID: 28966215 DOI: 10.1254/fpj.150.177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
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Waterman L, Stahl ST, Buysse DJ, Lenze EJ, Blumberger D, Mulsant B, Butters M, Gebara MA, Reynolds CF, Karp JF. Self-reported obstructive sleep apnea is associated with nonresponse to antidepressant pharmacotherapy in late-life depression. Depress Anxiety 2016; 33:1107-1113. [PMID: 27636232 PMCID: PMC5156576 DOI: 10.1002/da.22555] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2016] [Revised: 08/12/2016] [Accepted: 08/16/2016] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Obstructive sleep apnea (OSA) is frequently comorbid with late-life depression. The purpose of this project was to determine, using a sample of older adults with major depressive disorder, whether patient-reported diagnosis of OSA was associated with rate of response to venlafaxine. METHODS Participants from this multisite study were adults ≥60 years old (n = 468) with major depressive disorder and a Montgomery Asberg Depression Rating Scale (MADRS) score of ≥15. Depression response was the outcome variable, defined as a MADRS score of ≤10 for two consecutive assessments at the end of 12 weeks of open-label treatment with venlafaxine 300 mg/day. To assess OSA, participants were asked if they had been diagnosed with OSA using polysomnography. RESULTS Eighty participants (17.1%) reported a diagnosis of OSA prior to baseline. Participants with OSA were more likely to be male, report greater impairment on measures of health, experience a longer duration of the index episode, and receive an adequate antidepressant trial prior to entering the study. During the 12 weeks of treatment, 40.8% responded to treatment with venlafaxine (43.6%, n = 169/388 of the no OSA group, and 27.5%, n = 22/80 of the OSA group). Participants without OSA were 1.79 times more likely to respond to treatment (HR: 1.79 [95%CI: 1.13-2.86], P < .05) compared to those with OSA. CONCLUSIONS OSA may impair response to antidepressant pharmacotherapy in depressed older adults. Future studies of antidepressant response rates among depressed older adults with OSA should both prospectively diagnose OSA and monitor adherence to treatments such as continuous positive airway pressure.
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Affiliation(s)
- Lauren Waterman
- Department of Psychiatry, Western Psychiatric Institute and Clinic, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Sarah T. Stahl
- Department of Psychiatry, Western Psychiatric Institute and Clinic, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Daniel J. Buysse
- Department of Psychiatry, Western Psychiatric Institute and Clinic, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Eric J. Lenze
- Department of Psychiatry, Washington University in St. Louis, St. Louis, MO, USA
| | | | - Benoit Mulsant
- Centre for Addiction and Mental Health, University of Toronto
| | - Meryl Butters
- Department of Psychiatry, Western Psychiatric Institute and Clinic, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Marie Anne Gebara
- Department of Psychiatry, Western Psychiatric Institute and Clinic, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Charles F. Reynolds
- Department of Psychiatry, Western Psychiatric Institute and Clinic, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Jordan F. Karp
- Department of Psychiatry, Western Psychiatric Institute and Clinic, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
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Murphy DJ. Apneic events – A proposed new target for respiratory safety pharmacology. Regul Toxicol Pharmacol 2016; 81:194-200. [DOI: 10.1016/j.yrtph.2016.07.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2015] [Revised: 06/30/2016] [Accepted: 07/02/2016] [Indexed: 10/21/2022]
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Kubin L. Neural Control of the Upper Airway: Respiratory and State-Dependent Mechanisms. Compr Physiol 2016; 6:1801-1850. [PMID: 27783860 DOI: 10.1002/cphy.c160002] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Upper airway muscles subserve many essential for survival orofacial behaviors, including their important role as accessory respiratory muscles. In the face of certain predisposition of craniofacial anatomy, both tonic and phasic inspiratory activation of upper airway muscles is necessary to protect the upper airway against collapse. This protective action is adequate during wakefulness, but fails during sleep which results in recurrent episodes of hypopneas and apneas, a condition known as the obstructive sleep apnea syndrome (OSA). Although OSA is almost exclusively a human disorder, animal models help unveil the basic principles governing the impact of sleep on breathing and upper airway muscle activity. This article discusses the neuroanatomy, neurochemistry, and neurophysiology of the different neuronal systems whose activity changes with sleep-wake states, such as the noradrenergic, serotonergic, cholinergic, orexinergic, histaminergic, GABAergic and glycinergic, and their impact on central respiratory neurons and upper airway motoneurons. Observations of the interactions between sleep-wake states and upper airway muscles in healthy humans and OSA patients are related to findings from animal models with normal upper airway, and various animal models of OSA, including the chronic-intermittent hypoxia model. Using a framework of upper airway motoneurons being under concurrent influence of central respiratory, reflex and state-dependent inputs, different neurotransmitters, and neuropeptides are considered as either causing a sleep-dependent withdrawal of excitation from motoneurons or mediating an active, sleep-related inhibition of motoneurons. Information about the neurochemistry of state-dependent control of upper airway muscles accumulated to date reveals fundamental principles and may help understand and treat OSA. © 2016 American Physiological Society. Compr Physiol 6:1801-1850, 2016.
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Affiliation(s)
- Leszek Kubin
- Department of Biomedical Sciences, School of Veterinary Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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Brouillard C, Carrive P, Camus F, Bénoliel JJ, Similowski T, Sévoz-Couche C. Long-lasting bradypnea induced by repeated social defeat. Am J Physiol Regul Integr Comp Physiol 2016; 311:R352-64. [DOI: 10.1152/ajpregu.00021.2016] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2016] [Accepted: 05/18/2016] [Indexed: 12/17/2022]
Abstract
Repeated social defeat in the rat induces long-lasting cardiovascular changes associated with anxiety. In this study, we investigated the effects of repeated social defeat on breathing. Respiratory rate was extracted from the respiratory sinus arrhythmia (RSA) peak frequency of the ECG in rats subjected to social defeat for 4 consecutive days. Respiratory rate was recorded under anesthesia 6 days (D+10) or 26 days (D+30) after social defeat. At D+10, defeated (D) rats spent less time in the open arms of the elevated plus maze test, had heavier adrenal glands, and displayed bradypnea, unlike nondefeated animals. At D+30, all signs of anxiety had disappeared. However, one-half of the rats still displayed bradypnea (DL rats, for low respiratory rate indicated by a lower RSA frequency), whereas those with higher respiratory rate (DH rats) had recovered. Acute blockade of the dorsomedial hypothalamus (DMH) or nucleus tractus solitarii (NTS) 5-HT3 receptors reversed bradypnea in all D rats at D+10 and in DL rats at D+30. Respiratory rate was also recorded in conscious animals implanted with radiotelemetric ECG probes. DH rats recovered between D+10 and D+18, whereas DL rats remained bradypneic until D+30. In conclusion, social stress induces sustained chronic bradypnea mediated by DMH neurons and NTS 5-HT3 receptors. These changes are associated with an anxiety-like state that persists until D+10, followed by recovery. However, bradypnea may persist in one-half of the population up until D+30, despite apparent recovery of the anxiety-like state.
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Affiliation(s)
- Charly Brouillard
- Centre de Recherche de l'Institut du Cerveau et de la Moelle Epinière, Institut National de la Santé et de la Recherche Médicale, UMR-S 975, Centre National de la Recherche Scientifique, UMR 7225, Faculté de Médecine University Pierre and Marie Curie, Site Pitié-Salpêtrière, Paris, France
- Sorbonne Universités, University Pierre and Marie Curie University Paris 06, Institut National de la Santé et de la Recherche Médicale, UMRS1158, Neurophysiologie Respiratoire Expérimentale et Clinique, Paris, France
| | - Pascal Carrive
- Blood Pressure, Brain and Behavior Laboratory, School of Medical Sciences, University of New South Wales, Sydney, New South Wales, Australia
| | - Françoise Camus
- Centre de Recherche de l'Institut du Cerveau et de la Moelle Epinière, Institut National de la Santé et de la Recherche Médicale, UMR-S 975, Centre National de la Recherche Scientifique, UMR 7225, Faculté de Médecine University Pierre and Marie Curie, Site Pitié-Salpêtrière, Paris, France
| | - Jean-Jacques Bénoliel
- Centre de Recherche de l'Institut du Cerveau et de la Moelle Epinière, Institut National de la Santé et de la Recherche Médicale, UMR-S 975, Centre National de la Recherche Scientifique, UMR 7225, Faculté de Médecine University Pierre and Marie Curie, Site Pitié-Salpêtrière, Paris, France
| | - Thomas Similowski
- Sorbonne Universités, University Pierre and Marie Curie University Paris 06, Institut National de la Santé et de la Recherche Médicale, UMRS1158, Neurophysiologie Respiratoire Expérimentale et Clinique, Paris, France
- Assistance Publique-Hôpitaux de Paris, Groupe Hospitalier Pitié-Salpêtrière, Charles Foix, Service de Pneumologie et Réanimation Médicale, Paris, France; and
| | - Caroline Sévoz-Couche
- Centre de Recherche de l'Institut du Cerveau et de la Moelle Epinière, Institut National de la Santé et de la Recherche Médicale, UMR-S 975, Centre National de la Recherche Scientifique, UMR 7225, Faculté de Médecine University Pierre and Marie Curie, Site Pitié-Salpêtrière, Paris, France
- Sorbonne Universités, University Pierre and Marie Curie University Paris 06, Institut National de la Santé et de la Recherche Médicale, UMRS1158, Neurophysiologie Respiratoire Expérimentale et Clinique, Paris, France
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Wu W, Li Z, Tang T, Wu J, Liu F, Gu L. 5-HTR2A and IL-6 polymorphisms and obstructive sleep apnea-hypopnea syndrome. Biomed Rep 2015; 4:203-208. [PMID: 26893839 DOI: 10.3892/br.2015.558] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2015] [Accepted: 06/10/2015] [Indexed: 11/06/2022] Open
Abstract
At present, variants of the 5-hydroxytryptamine receptor 2A (5-HTR2A) and interleukin-6 (IL-6) genes may be susceptible markers to develop for obstructive sleep apnea-hypopnea syndrome (OSAHS). Therefore, the aim of the present study was to explore the potential associations between the 5-HTR2A and IL-6 single-nucleotide polymorphisms (SNPs) and OSAHS. In total there were 130 cases and 136 controls collected for genotyping of 5-HTR2A (rs6311) and IL-6 (rs1800796) SNPs. The association of these SNPs with OSAHS risk were evaluated by computing the odds ratio (OR) and 95% confidence interval (CI) from multivariate unconditional logistic regression analyses with adjustment for gender and age. The results indicated that the genotype and allele frequencies in these two loci (rs6311 and rs1800796) were not significantly different between the cases and controls. However, carrying the 'C' allele of rs6311 has a protective effect against OSAHS via the gender-specific comparison (P=0.0409; OR, 1.744; 95% CI, 1.021-2.978). The 'G' allele and 'CG' genotype distribution of rs1800796, and 'C' allele and 'CT' genotype distribution of rs6311 have significant differences between the mild and moderate group (P<0.05). Similarly, the genotype distribution of rs6311 has differences between mild and severe cases (P=0.0026). The current research demonstrated that variants of rs6311 have an association with OSAHS in males. Additionally, polymorphisms of rs6311 and rs1800796 have relevance to the severity of OSAHS.
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Affiliation(s)
- Wenjuan Wu
- Department of Respiratory, Zhejiang Hospital, Hangzhou, Zhejiang 310013, P.R. China
| | - Zhijun Li
- Department of Respiratory, Zhejiang Hospital, Hangzhou, Zhejiang 310013, P.R. China
| | - Tingyu Tang
- Department of Respiratory, Zhejiang Hospital, Hangzhou, Zhejiang 310013, P.R. China
| | - Jinyan Wu
- Department of Respiratory, Zhejiang Hospital, Hangzhou, Zhejiang 310013, P.R. China
| | - Fang Liu
- Department of Respiratory, Zhejiang Hospital, Hangzhou, Zhejiang 310013, P.R. China
| | - Liang Gu
- Department of Respiratory, Zhejiang Hospital, Hangzhou, Zhejiang 310013, P.R. China
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Lan F, Cao C, Liu J, Li W. Obstructive sleep apnea syndrome susceptible genes in the Chinese population: a meta-analysis of 21 case-control studies. Sleep Breath 2015; 19:1441-8. [PMID: 25917830 DOI: 10.1007/s11325-015-1176-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2015] [Revised: 03/10/2015] [Accepted: 03/31/2015] [Indexed: 12/24/2022]
Abstract
BACKGROUND Numbers of single nucleotide polymorphisms (SNPs) were identified as risk factors for obstructive sleep apnea syndrome (OSAS) in the Chinese population; however, published articles drew incompatible or even contradictory results. OBJECTIVE The aim of this study was to investigate the susceptible SNPs and risk of OSAS in the Chinese population. METHODS We conducted a meta-analysis of seven polymorphisms and risk of OSAS based on 21 case-control studies. RESULTS The results of our study showed that tumor necrosis factor-α (TNF-α) -308 G/A (OR = 3.70, 95 % CI = 1.39-9.83), gene-linked polymorphic region (LPR) (OR = 0.57, 95 % CI = 0.41-0.79), and variable number tandem repeat (VNTR) of the 5-hydroxytryptamine transporter gene (5-HTT) (OR = 3.44, 95 % CI = 1.49-7.95) polymorphisms were associated with OSAS risk in the Chinese population, while there was no significant association between 5-hydroxytryptamine 2A receptor (5-HTR2A) 102C/T, 5-HTR2A A1438G, angiotensin-converting enzyme (ACE) insertion (I)/deletion (D), or leptin receptor (LEPR)-Gln 223Arg polymorphism and risk of OSAS in the Chinese population. CONCLUSIONS Our study demonstrated that TNF-α 308 G/A, 5-HTT LPR, and 5-HTT-VNTR polymorphisms were associated with OSAS risk, whereas little association was observed between 5-HTR2A 102C/T, 5-HTR2A A1438G, ACE I/D, or LEPR-Gln 223Arg polymorphism and risk of OSAS in the Chinese population.
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Affiliation(s)
- Fen Lan
- Department of Respiratory and Critical Care Medicine, Second Affiliated Hospital, College of Medicine and Institute of Respiratory Diseases, Zhejiang University, Hangzhou, 310009, China
| | - Chao Cao
- Department of Respiratory and Critical Care Medicine, Second Affiliated Hospital, College of Medicine and Institute of Respiratory Diseases, Zhejiang University, Hangzhou, 310009, China.,Department of Respiratory Medicine, Affiliated Hospital of School of Medicine, Ningbo University, Ningbo, 315020, China
| | - Jinkai Liu
- Department of Respiratory and Critical Care Medicine, Second Affiliated Hospital, College of Medicine and Institute of Respiratory Diseases, Zhejiang University, Hangzhou, 310009, China
| | - Wen Li
- Department of Respiratory and Critical Care Medicine, Second Affiliated Hospital, College of Medicine and Institute of Respiratory Diseases, Zhejiang University, Hangzhou, 310009, China.
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Chiu YC, Hu HY, Lee FP, Huang HM. Tension-type headache associated with obstructive sleep apnea: a nationwide population-based study. J Headache Pain 2015; 16:34. [PMID: 25896615 PMCID: PMC4408303 DOI: 10.1186/s10194-015-0517-5] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2015] [Accepted: 04/11/2015] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND There is still controversy regarding the association between primary headaches and obstructive sleep apnea. We explored the relationship between tension-type headache (TTH) and obstructive sleep apnea (OSA) using a large nationwide population-based data set in Taiwan. METHODS We identified 4759 patients diagnosed with OSA from the Taiwan Longitudinal Health Insurance Database, based on polysomnography, as the OSA group. We then randomly selected 19036 subjects without OSA, matched by sex and age, to serve as the non-OSA group. The multivariate Cox proportional hazards model with matching for age and sex was used to assess the possible associations between TTH and OSA among the patients. RESULTS The prevalence of TTH was 10.2% among OSA patients and 7.7% among non-OSA patients (p < 0.001). The multivariate Cox proportional hazards model revealed patients with OSA were more likely to have TTH (hazard ratio, 1.18; 95% CI, 1.06-1.31) (p = 0.003) than patients in the non-OSA group. CONCLUSION Patients with OSA had a higher likelihood of developing TTH than patients in the non-OSA group. Further studies of physiological patterns between OSA and TTH are needed to confirm the study findings.
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Affiliation(s)
- Yu-Chwen Chiu
- Department of Otolaryngology, Taipei City Hospital, Taipei, Taiwan.
| | - Hsiao-Yun Hu
- Department of Education and Research, Taipei City Hospital, Taipei, Taiwan. .,Department of Public Health, Institute of Public Health, National Yang Ming University, Taipei, Taiwan.
| | - Fei-Peng Lee
- Department of Otolaryngology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan. .,Department of Otolaryngology, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan.
| | - Hung-Meng Huang
- Department of Otolaryngology, Taipei City Hospital, Taipei, Taiwan. .,Department of Otolaryngology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan.
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Zhang B, Hao Y, Jia F, Li X, Tang Y, Zheng H, Liu W. Effect of sertraline on breathing in depressed patients without moderate-to-severe sleep-related breathing disorders. Sleep Breath 2015; 19:1377-86. [PMID: 25758299 DOI: 10.1007/s11325-015-1152-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2015] [Accepted: 02/25/2015] [Indexed: 11/25/2022]
Abstract
BACKGROUND Previous studies have reported that selective serotonin reuptake inhibitors (SSRIs) might improve sleep-related breathing disorders (SRBDs). However, the effects of SSRIs on breathing are not evaluated in subjects without moderate-to-severe SRBDs. Further, many symptoms of depression and SRBDs overlap, and so, it is interesting whether there are interactions between breathing and psychopathologic symptoms during SSRI treatment for depression. METHODS Data were taken from an open-label 8-week trial of sertraline in depressed patients with insomnia (n = 31). The depressed patients were administered 50 mg sertraline at 8 AM on the first day, and the dosage was subsequently titrated up to a maximum of 200 mg/day during the 8-week trial. All the patients were tested by repeated polysomnography (PSG) (baseline, 1st day, 14th day, 28th day, and 56th day). Sleep-disordered breathing events were categorized as apneas, hypopneas, and respiratory event-related arousals (RERAs). RESULTS The clinical responses and PSG characteristics improved continuously during the 8-week trial. From the 14th day on, the RERA index during all-night and non-rapid eye movement (NREM) sleep became stable and significantly higher than baseline and the first day (RERA index 7.3 ± 2.2 at baseline, 7.3 ± 2.5 on the 1st day, 4.4 ± 1.9 on the 14th day, 3.9 ± 1.3 on the 28th day, 4.2 ± 2.0 on the 56th day, F = 5.71, P = 0.02; NREM-RERA index 6.2 ± 2.0 at baseline, 6.3 ± 2.3 on the 1st day, 3.2 ± 1.5 on the 14th day, 3.5 ± 0.9 on the 28th day, 3.2 ± 1.7 on the 56th day, F = 4.92, P = 0.03). Additionally, the NREM-apnea index showed a similar pattern to that of the RERA index and reached a significant difference between baseline (1.0 ± 0.5) and the 14th day (0.5 ± 0.4) (KW = 4.28, P = 0.047). Compared to the no-improvement group, the improvement group with a decreasing score rate of the respiratory disturbance index (RDI) greater than or equal to -50 % had a more positive decreasing score rate of slow wave sleep (SWS) (439.0 ± 78.2 vs 373.2 ± 77.9 %, T = 3.46, P = 0.04) and a more negative decreasing score rate on the arousal index (-43.7 ± 16.7 vs -26.6 ± 9.7 %, T = 9.16, P = 0.01), Pittsburgh Sleep Quality Index (PSQI) scores (-65.1 ± 33.7 vs -49.6 ± 21.4 %, T = 4.74, P = 0.05), and Epworth Sleepiness Scale (ESS) scores (-55.7 ± 21.3 vs -36.4 ± 17.5 %, T = 6.44, P = 0.02). DISCUSSION This research indicates that SRBDs could be improved to some extent by sertraline treatment, which might be more common in patients with relatively more severe sleep-disordered breathing (e.g., RDI ≥ 10 in the current study). Although the sertraline-induced SRBD improvement seems not to have a significant clinical effect, the SRBD improvement group with decreasing score rate of RDI greater than or equal to -50 % has better subjective and objective sleep aspects than the no-improvement group. Thus, the fact that the SRBDs' improvement was related to SSRIs might have a potential clinical benefit in the antidepressant treatment.
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Affiliation(s)
- Bin Zhang
- Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangdong Mental Health Center, Guangzhou, 510120, China.
| | - Yanli Hao
- Department of Human Anatomy, Guang Zhou Medical University, Guangzhou, 510182, China
| | - Fujun Jia
- Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangdong Mental Health Center, Guangzhou, 510120, China
| | - Xueli Li
- Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangdong Mental Health Center, Guangzhou, 510120, China
| | - Yi Tang
- Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangdong Mental Health Center, Guangzhou, 510120, China
| | - Huirong Zheng
- Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangdong Mental Health Center, Guangzhou, 510120, China
| | - Wuhan Liu
- Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangdong Mental Health Center, Guangzhou, 510120, China
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Primeau MM, Tal JZ, O’Hara R. Depression. Sleep Med 2015. [DOI: 10.1007/978-1-4939-2089-1_38] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Davisson RL, Bates JN, Johnson AK, Lewis SJ. Effects of intracerebroventricular injections of 5-HT on systemic vascular resistances of conscious rats. Microvasc Res 2014; 95:116-23. [PMID: 25128748 PMCID: PMC4188728 DOI: 10.1016/j.mvr.2014.08.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2014] [Revised: 07/18/2014] [Accepted: 08/07/2014] [Indexed: 12/21/2022]
Abstract
The aims of this study were to determine (i) the effects of intracerebroventricular (i.c.v.) injections of 5-hydroxytryptamine (5-HT, 10μg) on mean arterial blood pressure (MAP), heart rate (HR) and mesenteric (MR), renal (RR) and hindquarter (HQR) vascular resistances of conscious rats, (ii) the central 5-HT receptor subtype which mediates these effects, and (iii) the role of nitric oxide (NO) in the expression of these responses. The i.c.v. injection of 5-HT had minor effects on MAP but produced a decrease in HR (-18±4%), which lasted for 20min. The i.c.v. injection of 5-HT elicited marked increases in MR (+50±7%) and reductions in HQR (-31±3%). These responses occurred promptly and lasted for 25-35min. 5-HT also produced a transient decrease in RR (-26±8% at 10min). All of these responses were prevented by the prior i.c.v. injection of the 5-HT1/5-HT2-receptor antagonist, methysergide (10μg). The intravenous injection of the NO synthesis inhibitor, L-NAME (25μmol/kg), produced a sustained pressor response, bradycardia and increases in MR, RR and HQR. Subsequent i.c.v. injection of 5-HT produced a minor pressor response (+7±2%), bradycardia (-18±3%), an increase in MR (+52±8%) but no decreases in RR or HQR. This study demonstrates that i.c.v. 5-HT differentially affects peripheral vascular resistances by activation of central 5-HT1/5-HT2-receptors. It appears that L-NAME did not interfere with the central actions of 5-HT as it did not prevent the 5-HT-induced bradycardia or mesenteric vasoconstriction. Since the 5-HT-induced falls in RR and HQR were abolished by L-NAME, it is possible that these responses are mediated by an active neurogenic process involving the release of NO within the vasculature.
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Affiliation(s)
- Robin L. Davisson
- Departments of Biomedical Sciences (College of Veterinary Medicine), Ithaca, New York, and Cell and Developmental Biology (Weil Cornell Medical College), New York, New York, USA
| | - James N. Bates
- Department of Anesthesia, University of Iowa, Iowa City, Iowa, USA
| | - Alan Kim Johnson
- Departments of Psychology, Health and Human Physiology, and Pharmacology, and the Francois M. Abboud Cardiovascular Research Center, The University of lowa, Iowa City, Iowa, USA
| | - Stephen J. Lewis
- Departments of Pediatrics and Pharmacology, Case Western Reserve University, Cleveland, Ohio, USA
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Medina AB, Lechuga DA, Escandón OS, Moctezuma JV. Update of sleep alterations in depression. Sleep Sci 2014; 7:165-9. [PMID: 26483922 PMCID: PMC4559588 DOI: 10.1016/j.slsci.2014.09.015] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2013] [Revised: 08/12/2014] [Accepted: 08/27/2014] [Indexed: 01/23/2023] Open
Abstract
Sleep disturbances in depression are up to 70%. Patients frequently have difficulty in falling asleep, frequent awakenings during the night and non-restorative sleep. Sleep abnormalities in depression are mainly characterized by increased rapid eye movement (REM) sleep and reduced slow wave sleep. Among the mechanisms of sleep disturbances in depression are hyperactivation of the hypothalamic-pituitary-adrenal axis, CLOCK gene polymorphism and primary sleep disorders. The habenula is a structure regulating the activities of monoaminergic neurons in the brain. The hyperactivation of the habenula has also been implicated, together with sleep disturbances, in depression. The presence of depression in primary sleep disorders is common. Sleep disturbances treatment include pharmacotherapy or Cognitive Behavioral Therapy.
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McDonald FB, Skelly JR, O'Halloran KD. The β2 -adrenoceptor agonist terbutaline recovers rat pharyngeal dilator muscle force decline during severe hypoxia. Oral Dis 2014; 21:e121-7. [PMID: 24725067 DOI: 10.1111/odi.12247] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2014] [Revised: 03/28/2014] [Accepted: 04/08/2014] [Indexed: 11/28/2022]
Abstract
RATIONALE Obstructive sleep apnoea syndrome (OSAS) is a debilitating condition characterized by recurrent occlusions of the pharyngeal airway during sleep accompanied by arterial hypoxaemia. Upper airway muscle dysfunction is implicated in the pathophysiology of OSAS. Pharmacological agents that improve muscle contractile and endurance properties may have therapeutic value. AIM We tested the hypothesis that the β(2) -adrenoceptor agonist terbutaline improves rat sternohyoid muscle performance especially during hypoxic stress. METHODS Isometric contractile and endurance properties were examined ex vivo in Krebs solution at 35°C. Muscles were incubated in tissue baths under hyperoxic (95% O(2) /5% CO(2)) conditions in the absence (control) or presence of the β(2) -adrenoceptor agonist terbutaline (1 μM). In additional experiments under hypoxic (95% N(2) /5% CO(2)) conditions, the effects of terbutaline were examined in the presence of the β-adrenoceptor antagonist propranolol (1 μM). RESULTS Hypoxia significantly impaired sternohyoid force production. Terbutaline completely recovered hypoxic depression of force, an effect that was blocked by co-application with propranolol. CONCLUSION The β(2) -adrenoceptor agonist terbutaline completely recovers hypoxic depression of upper airway muscle force. β(2) -adrenoceptor agonists warrant investigation in animal models of OSAS reporting upper airway and diaphragm muscle dysfunction.
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Affiliation(s)
- F B McDonald
- School of Medicine and Medical Science, University College Dublin, Dublin, Ireland
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Schröder CM, Primeau MM, Hallmayer JF, Lazzeroni LC, Hubbard JT, O’Hara R. Serotonin transporter polymorphism is associated with increased apnea-hypopnea index in older adults. Int J Geriatr Psychiatry 2014; 29:227-35. [PMID: 23754303 PMCID: PMC3883911 DOI: 10.1002/gps.3994] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2013] [Accepted: 05/02/2013] [Indexed: 12/22/2022]
Abstract
RATIONALE A functional polymorphism of the serotonin transporter gene (5-HTTLPR) has previously been related to upper airway pathology, but its contribution to obstructive sleep apnea (OSA), a highly prevalent sleep disorder in older adults, remains unclear. OBJECTIVES We aimed to investigate the relationship between apnea-hypopnea index (AHI) and genetic variations in the promoter region of the 5-HTTLPR in older adults. METHODS DNA samples from 94 community-dwelling older adults (57% female, mean age 72 ± 8) were genotyped for the 5-HTTLPR polymorphism. All participants were assessed in their homes with full ambulatory polysomnography in order to determine AHI and related parameters such as hypoxia, sleep fragmentation, and self-reported daytime sleepiness. RESULTS The 5-HTT l allele was significantly associated with AHI (p = 0.019), with l allele carriers displaying a higher AHI than s allele homozygotes. A single allele change in 5-HTTLPR genotype from s to l resulted in an increase of AHI by 4.46 per hour of sleep (95% CI, 0.75-8.17). The l allele was also associated with increased time during sleep spent at oxygen saturation levels below 90% (p = 0.014). CONCLUSIONS The observed significant association between the 5-HTTLPR l allele and severity of OSA in older adults suggests that the l allele may be important to consider when assessing for OSA in this age group. This association may also explain some of the observed variability among serotonergic pharmacological treatment studies for OSA, and 5-HTT genotype status may have to be taken into account in future therapeutic trials involving serotonergic agents.
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Affiliation(s)
- Carmen M. Schröder
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, 401 Quarry Road, Stanford University, Stanford, CA 94305-5550, USA
- Department of Psychiatry and Behavioral Sciences, Strasbourg University Hospital and Strasbourg University, 1 place de l’hôpital, 67000 Strasbourg, France
- CNRS UPR 3212, Institute for Cellular and Integrative Neuroscience, Strasbourg, France
- University Sleep Clinic, Department of Neurology, Strasbourg University Hospital, Strasbourg, France
| | - Michelle M. Primeau
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, 401 Quarry Road, Stanford University, Stanford, CA 94305-5550, USA
| | - Joachim F. Hallmayer
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, 401 Quarry Road, Stanford University, Stanford, CA 94305-5550, USA
| | - Laura C. Lazzeroni
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, 401 Quarry Road, Stanford University, Stanford, CA 94305-5550, USA
| | - Jeffrey T. Hubbard
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, 401 Quarry Road, Stanford University, Stanford, CA 94305-5550, USA
- CNRS UPR 3212, Institute for Cellular and Integrative Neuroscience, Strasbourg, France
- University Sleep Clinic, Department of Neurology, Strasbourg University Hospital, Strasbourg, France
| | - Ruth O’Hara
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, 401 Quarry Road, Stanford University, Stanford, CA 94305-5550, USA
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Xu H, Guan J, Yi H, Yin S. A systematic review and meta-analysis of the association between serotonergic gene polymorphisms and obstructive sleep apnea syndrome. PLoS One 2014; 9:e86460. [PMID: 24475124 PMCID: PMC3903532 DOI: 10.1371/journal.pone.0086460] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2013] [Accepted: 12/13/2013] [Indexed: 01/18/2023] Open
Abstract
Background 5-Hydroxytryptamine receptor (5-HTR) and 5-hydroxytryptamine transporter (5-HTT) gene polymorphisms have been reported to be associated with susceptibility to obstructive sleep apnea syndrome (OSAS). The associations, derived from sporadic, inconsistent, small-sample-size studies, need to be evaluated further in a meta-analysis. Methods Relevant studies were identified by searching PubMed, Embase, The Cochrane Library, China National Knowledge Infrastructure (CNKI), Wanfang, and Weipu. Eligible data were extracted from each included study. Odds ratios (ORs) were calculated using a fixed-effects or a random-effects model. The ORs and 95% confidence interval (CI) were used to assess the strength of the association between serotonergic gene polymorphisms and OSAS in the dominant and recessive models, as well as alleles. The Q statistic was used to evaluate homogeneity and Begg’s test was used to assess publication bias. Results Eight studies were finally included in the meta-analysis of the association between 5-HTR2A gene variants (including 102T/C and 1438G/A), 5-HTT gene polymorphisms (including 5-HTT gene-linked promoter region (5-HTTLRP), and serotonin transporter intron 2 variable number tandem repeat (STin2VNTR) and OSAS risk. The G allele of 5-HTR2A 1438G/A, long 5-HTTLPR, and 10-tandem-repeats STin2VNTR were shown to increase OSAS susceptibility, with ORs of 2.33 (A vs. G, 95% CI 1.48–3.66), 1.24 (L vs. S, 95% CI: 1.04–1.49), and 2.87 (10 vs. 12, 95% CI: 1.38–5.97), respectively. These significant differences were determined in both dominant and recessive models. Of the 5-HTR2A 1438G/A gene polymorphism, the AA genotype increased the OSAS risk, with an OR of 4.21 (95% CI: 2.83–6.25) in a recessive model in male OSAS patients, but no significant association was found in females. Conclusions Our meta-analysis demonstrated that polymorphisms in the 5-HTR2A 1438G/A and 5-HTT genes contributed to susceptibility to OSAS. The A allele of the 1438G/A gene polymorphism is predominantly distributed in males and increased the OSAS risk significantly.
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Affiliation(s)
- Huajun Xu
- Department of Otolaryngology, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, Otolaryngology Institute of Shanghai Jiao Tong University, Shanghai, China
| | - Jian Guan
- Department of Otolaryngology, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, Otolaryngology Institute of Shanghai Jiao Tong University, Shanghai, China
- * E-mail: (JG); (SY)
| | - Hongliang Yi
- Department of Otolaryngology, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, Otolaryngology Institute of Shanghai Jiao Tong University, Shanghai, China
| | - Shankai Yin
- Department of Otolaryngology, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, Otolaryngology Institute of Shanghai Jiao Tong University, Shanghai, China
- * E-mail: (JG); (SY)
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Chen H, Hu K, Zhu J, Xianyu Y, Cao X, Kang J, He J, Zhao P, Mei Y. Polymorphisms of the 5-hydroxytryptamine 2A/2C receptor genes and 5-hydroxytryptamine transporter gene in Chinese patients with OSAHS. Sleep Breath 2013; 17:1241-8. [PMID: 23494654 DOI: 10.1007/s11325-013-0829-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2012] [Revised: 02/05/2013] [Accepted: 03/04/2013] [Indexed: 10/27/2022]
Abstract
BACKGROUND It is known that there is a genetic predisposition to OSAHS. Polymorphisms of the 5-hydroxytryptamine (5-HT) 2A/2C receptors (5-HTR 2A/2C) genes and 5-HT transporter (5-HTT) gene may be associated with the pathogenesis of obstructive sleep apnea-hypopnea syndrome (OSAHS). OBJECTIVES In this study, we aimed to investigate the prevalence of polymorphisms of the 5-HTR 2A/2C genes and the 5-HTT gene in the Chinese Han OSAHS population. METHODS A total of 226 unrelated subjects of the Chinese Han population, including 121 OSAHS patients and 105 healthy controls, were involved in the study. The A1438G and T102C polymorphisms of the 5-HTR 2A gene, G796C polymorphisms of the 5-HTR 2C gene, and two polymorphisms (gene-linked polymorphic region [LPR] and variable number tandem repeat [VNTR]) of the 5-HTT gene were identified by polymerase chain reaction (PCR)-RFLP. RESULTS Compared with the control group, the OSAHS group had significantly higher AA genotype and A allele frequencies in the A1438G polymorphisms of the 5-HTR 2A gene, and had significantly higher frequencies of 10/10, 12/10 genotypes and the allele 10 of 5-HTT-VNTR. There were no significant differences between the genotype distribution and allele frequencies of the OSAHS group and the control group regarding the T102C polymorphisms of the 5-HTR 2A gene and the G796C polymorphisms of the 5-HTR 2C gene, the frequencies of the S or L allele and the S/S, S/L or L/L genotypes in 5-HTT-LPR. CONCLUSIONS The A1438G polymorphism of the 5-HTR 2A gene might be involved in the pathogenesis in OSAHS subjects of the Chinese Han population. Meanwhile, our findings support the argument that 5-HTT polymorphism appears to be associated with susceptibility to OSAHS, because the allele 10 of 5-HTT-VNTR might be a susceptible factor.
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Affiliation(s)
- Hongbin Chen
- Division of Respiratory Disease, Renmin Hospital of Wuhan University, 99 Zhangzhidong Road, Wuchang, Wuhan, 430060, China
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Skelly JR, Rowan SC, Jones JFX, O'Halloran KD. Upper airway dilator muscle weakness following intermittent and sustained hypoxia in the rat: effects of a superoxide scavenger. Physiol Res 2012; 62:187-96. [PMID: 23234416 DOI: 10.33549/physiolres.932405] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
Obstructive sleep apnoea syndrome (OSAS) is a common disorder associated with upper airway muscle dysfunction. Agents that improve respiratory muscle performance may have considerable therapeutic value. We examined the effects of acute exposure to sustained and intermittent hypoxia on rat pharyngeal dilator muscle function. Additionally, we sought to test the efficacy of antioxidant treatment in ameliorating or preventing hypoxia-related muscle dysfunction. Isometric contractile and endurance properties of isolated rat sternohyoid muscle bundles were examined at 35 °C in vitro. Muscle bundles were exposed to one of four gas treatments: hyperoxia (control), sustained hypoxia (SH), intermittent hypoxia (IH) or hypoxia/re-oxygenation (HR), in the absence or presence of the superoxide scavenger--Tempol (10 mM). Stress-frequency relationship was determined in response to electrical stimulation (10-100 Hz in increments of 10-20 Hz, train duration: 300 ms). Muscle performance was also assessed during repetitive muscle stimulation (40 Hz, 300 ms every 2 s for 2.5 min). Compared to control, IH and HR treatments significantly decreased sternohyoid muscle force. The negative inotropic effect of the two gas protocols was similar, but both were of lesser magnitude than the effects of SH. SH, but not IH and HR, increased muscle fatigue. Tempol significantly increased sensitivity to stimulation in all muscle preparations and caused a leftward shift in the stress-frequency relationship of IH and SH treated muscles. Tempol did not ameliorate sternohyoid muscle fatigue during SH. We conclude that Tempol increases upper airway muscle sensitivity to stimulation but only modestly ameliorates respiratory muscle weakness during intermittent and sustained hypoxic conditions in vitro. Respiratory muscle fatigue during sustained hypoxia appears unrelated to oxidative stress.
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Affiliation(s)
- J R Skelly
- Health Sciences Centre, University College Dublin, Belfield, Dublin, Ireland.
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Lin WC, Winkelman JW. Obstructive sleep apnea and severe mental illness: evolution and consequences. Curr Psychiatry Rep 2012; 14:503-10. [PMID: 22872493 DOI: 10.1007/s11920-012-0307-6] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Sleep complaints are commonly encountered in psychiatric clinics. Underlying medical disorders or sleep disorders need to be identified and treated to optimize treatment of the mental illness. Excessive daytime sleepiness, which is the main symptom of obstructive sleep apnea (OSA), overlaps with those of many severe mental illnesses. Medication side effects or the disorder itself maybe account for daytime sleepiness but comorbid OSA is a possibility that should not be overlooked. The diagnosis of OSA is straightforward but treatment compliance is problematic in psychiatric patients. This article summarizes studies concerning comorbid OSA in patients with severe mental illness and includes suggestions for future investigations.
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Affiliation(s)
- Wei-Chen Lin
- Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Taiwan
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Abstract
This review summarizes the brain mechanisms controlling sleep and wakefulness. Wakefulness promoting systems cause low-voltage, fast activity in the electroencephalogram (EEG). Multiple interacting neurotransmitter systems in the brain stem, hypothalamus, and basal forebrain converge onto common effector systems in the thalamus and cortex. Sleep results from the inhibition of wake-promoting systems by homeostatic sleep factors such as adenosine and nitric oxide and GABAergic neurons in the preoptic area of the hypothalamus, resulting in large-amplitude, slow EEG oscillations. Local, activity-dependent factors modulate the amplitude and frequency of cortical slow oscillations. Non-rapid-eye-movement (NREM) sleep results in conservation of brain energy and facilitates memory consolidation through the modulation of synaptic weights. Rapid-eye-movement (REM) sleep results from the interaction of brain stem cholinergic, aminergic, and GABAergic neurons which control the activity of glutamatergic reticular formation neurons leading to REM sleep phenomena such as muscle atonia, REMs, dreaming, and cortical activation. Strong activation of limbic regions during REM sleep suggests a role in regulation of emotion. Genetic studies suggest that brain mechanisms controlling waking and NREM sleep are strongly conserved throughout evolution, underscoring their enormous importance for brain function. Sleep disruption interferes with the normal restorative functions of NREM and REM sleep, resulting in disruptions of breathing and cardiovascular function, changes in emotional reactivity, and cognitive impairments in attention, memory, and decision making.
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Affiliation(s)
- Ritchie E Brown
- Laboratory of Neuroscience, VA Boston Healthcare System and Harvard Medical School, Brockton, Massachusetts 02301, USA
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Daabis R, Gharraf H. Predictors of anxiety and depression in patients with obstructive sleep apnea. EGYPTIAN JOURNAL OF CHEST DISEASES AND TUBERCULOSIS 2012. [DOI: 10.1016/j.ejcdt.2012.10.032] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
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Lin CM, Huang YS, Guilleminault C. Pharmacotherapy of obstructive sleep apnea. Expert Opin Pharmacother 2012; 13:841-57. [DOI: 10.1517/14656566.2012.666525] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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