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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 3 of 3. This is the beginning of the thread.
Posted by Abby on February 15, 2000, at 19:12:42
Noa,
I thought you might find this article interesting.
Maybe you could try to replace Serzone with Remeron.Mirtazapine, a Mixed-Profile Serotonin Agonist/Antagonist,
Suppresses Sleep Apnea in the Rat.Carley DW, Radulovacki M
Departments of Medicine, Pharmacology, and Bioengineering, University of Illinois at Chicago, Chicago, Illinois.
[Record supplied by publisher]
Serotonin enhancing drugs, including L-tryptophan and, more recently, fluoxetine and paroxetine, have been tested as pharmacologic treatments for sleep apnea syndrome. Although some patients have demonstrated reduced apnea expression after treatment with these compounds, this improvement has been restricted to nonrapid eye movement (NREM) sleep, with some patients showing no improvement. This study reports the effects of mirtazapine, an antidepressant with 5-HT(1) agonist as well as 5-HT(2) and 5-HT(3) antagonist effects, on sleep and respiration in an established animal model of central apnea. We studied nine adult male Sprague-Dawley rats chronically instrumented for sleep staging. In random order on separate days, rats were recorded after intraperitoneal injection of: (1) saline, (2) 0.1 mg/kg +/- mirtazapine (labeled as Remeron), (3) 1 mg/kg mirtazapine, or (4) 5 mg/ kg mirtazapine. With respect to saline injections, mirtazapine at all three doses reduced apnea index during NREM sleep by more than 50% (p < 0.0001) and during REM sleep by 60% (p < 0.0001)for at least 6 h. In association with this apnea suppression normalized inspiratory minute ventilation increased during all wake/sleep states (p < 0.001 for each state). The duration of NREM sleep was unaffected by any dose of mirtazapine (p = 0.42), but NREM EEG delta power was increased by more than 30% at all doses (p = 0.04),indicating improved NREM sleep consolidation after mirtazapine injection. We conclude that mirtazapine, over a 50-fold dose range, significantly reduces central apnea expression during NREM and REM sleep in the rat. The efficacy of this compound to suppress apnea in all sleep stages most probably arises from its mixed agonist/antagonist profile at serotonin receptors. The implications of these findings for the management of sleep
apnea syndrome must be verified by appropriate clinical trials. Carley DW, Radulovacki M. Mirtazapine, a mixed-profile serotonin agonist/antagonist, suppresses sleep apnea in the rat.
PMID: 10588592
That phrase "in the rat" seems so absurd, somehow.Abby
Posted by Noa on February 15, 2000, at 20:15:07
In reply to Noa==sleep apnea and the anti-depressant Remeron, posted by Abby on February 15, 2000, at 19:12:42
Abby, thanks. That is interesting. This study, tho, is about "central" sleep apnea, which is apnea caused by a failure of the brain to signal the body to breathe. From what I have read, there is some thought that a lot of this type of apnea comes from a problem in detecting the level of CO2. Usually, once a certain amount of CO2 is in the blood, the brain detects this and signals the breathing apparatus to take another breath.
My type of apnea is "obstructive" apnea, which comes from the airway being blocked, usually when it collapses from low muscle tone, extra body fat, or if the soft palate, etc. are very fleshy.
What is interesting, tho, is that it seems that REM sleep is when a lot of the apnea events of either kind happen. One reason I think an SSRI could reduce apnea of either kind is that ther is a lot of REM sleep in depression, and I would assume, perhaps wrongly, that when taking antidepressants, a depressed person's REM sleep is reduced. Not that reducing REM is a good way to treat apnea, because usually the effect is the other way around. My apnea reduced my REM sleep to 25% of what it should have been, because the apnea episodes kept interrupting the REM stage, as well as stage 4.
Well, probably more than you wanted to know...thanks for the article.
Posted by torchgrl on February 15, 2000, at 23:00:03
In reply to Re: Noa==sleep apnea and the anti-depressant Remeron, posted by Noa on February 15, 2000, at 20:15:07
Aaagh, now I did it too! As I said before I closed the response window without confirming...
Don't quote me on this, but I think I've read that SSRIs as a class reduce REM sleep (in addition to whatever effect they have on the depression), so would seem to be even more effective than other ADs as far as reducing apnea goes, if there is definitely a correlation between sleep stages and apnea events.
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