obstructive sleep apnea (osa) is characterized by repetitive collapse or ‘obstruction’ of the pharyngeal airway during sleep. furthermore, osa is associated with cardiovascular morbidity and mortality, making osa a major health concern. this collapsibility of the upper airway is measured as the critical closing pressure or pcrit. 2) the ability of the upper airway dilator muscles to activate and reopen the airway during sleep (i.e. the propensity for hypopneas/apneas to lead to arousal and fragmented sleep) measured as the epiglottic pressure occurring just at the time of arousal and 4) the stability of the ventilatory feedback loop (i.e. continuous positive airway pressure (cpap) is the most common treatment for osa but it is often poorly tolerated; only ~50% of patients diagnosed with osa continue therapy beyond 3 months. in addition to these alternative therapies, the use of pharmacological agents for the treatment of osa has been gaining widespread interest.
based on studies showing that increasing the arousal threshold with a different hypnotic improves sleep apnea severity, we hypothesize that trazodone will increase the arousal threshold and this will be associated with an improvement in sleep apnea severity. initially, participants will be randomized to the trazodone or placebo arm where they will have both a clinical polysomnography (psg) with the addition of an epiglottic pressure cathether. ahi) and the epiglottic catheter allows the calculation of the arousal threshold to be completed. during the placebo arm, subjects will be given a placebo to take before bed. participants will have at least a 1-week washout period before cross over to the next arm of the study whereby the clinical psg will be repeated. talk with your doctor and family members or friends about deciding to join a study. to learn more about this study, you or your doctor may contact the study research staff using the contacts provided below.
we hypothesized that trazodone would increase the arousal threshold and improve the apnea/hypopnea index (ahi) in selected patients with osa. as such, a number of studies have attempted to manipulate pharmacologically the arousal threshold in patients with osa using various sedatives/hypnotic agents. given this uncertainty, we sought to determine if trazodone would reduce the number of arousals and improve osa severity via changes in arousal threshold in people with osa under minimal instrumentation to mimic real-world conditions. subjects were additionally instrumented with an epiglottic pressure catheter (model mcp-500; millar, houston, tx) for the determination of the arousal threshold during sleep as described previously (21, 22). responders were defined a priori as the upper 50th percentile of subjects based on the percent change in ahi between placebo and trazodone conditions.
within the trazodone condition, there were a total of 68 arousal threshold measurements obtained in n2 sleep, 67 in n1 sleep, 14 in stage rem sleep, and 0 in n3 sleep. the major findings of our crossover physiological study suggest that 100 mg of trazodone administered just before sleep significantly improves ahi but was not found to cause significant alterations in the respiratory arousal threshold in an unselected group of patients with osa. trazodone may be leading to changes in sleep architecture rather than affecting the arousal threshold importantly within a particular stage. the effect of trazodone on osa might allow for more individualized therapies and new treatment opportunities for a particular group of patients with osa who are not hypoxemic for large portions of the night. participated in the experimental design of this project.
conclusions: these findings suggest that trazodone could be effective therapy for patients with osa without worsening hypoxemia. future studies should focus on trazodone at 100 mg increased the effort-related arousal threshold in response to hypercapnia in obstructive sleep apnoea patients and allowed them to based on studies showing that increasing the arousal threshold with a different hypnotic improves sleep apnea severity, we hypothesize that, .
trazodone increases the respiratory arousal threshold in patients with obstructive sleep apnea and a low arousal threshold without major impairment in dilator muscle activity or upper airway collapsibility. the investigators hypothesize that trazodone does not worse nocturnal oxygen saturation in insomnic ischemic stroke patients with obstructive sleep apnea rationale: a low respiratory arousal threshold is a physiological trait involved in obstructive sleep apnea (osa) pathogenesis. trazodone trazodone modestly decreases osa severity and improves minimum oxygen saturation in ischemic stroke patients with osa. typically, the, .
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