Response of obstructive sleep apnea to fluoxetine and protriptyline.

Protripyline is the pharmacologic agent most commonly used to treat obstructive sleep apnea (OSA); however, its anticholinergic side effects make it intolerable to many patients. Because serotonin may be a central respiratory stimulant and because the serotonin-uptake inhibitor, fluoxetine, is usually well tolerated, we wanted to try fluoxetine in the treatment of OSA. Therefore, we compared the effect of fluoxetine to that of protriptyline in 12 patients with OSA. Both drugs significantly decreased the proportion of REM sleep time and decreased the number of apneas or hypopneas in NREM sleep. The response to fluoxetine was equivalent to that of protriptyline; however, for the group as a whole, there was no significant improvement in the number of arterial oxygen desaturation events, the level of arterial oxygen desaturation, or the number of arousals with either agent. Although there was wide variability in the response to each medication, six of the 12 patients had good responses, including improvement in oxygenation, to either fluoxetine or protriptyline. Three patients could not complete the trial of protriptyline. We conclude that fluoxetine is beneficial to some, but not all, patients with OSA. Fluoxetine was better tolerated than protriptyline.

[1]  T. Gislason,et al.  Uvulopalatopharyngoplasty in the sleep apnea syndrome. Predictors of results. , 1988, Archives of otolaryngology--head & neck surgery.

[2]  T. Dick,et al.  Serotonin-mediated excitation of recurrent laryngeal and phrenic motoneurons evoked by stimulation of the raphe obscurus , 1987, Brain Research.

[3]  J A Neubauer,et al.  Correlation between genioglossal and diaphragmatic responses to hypercapnia during sleep. , 1987, The American review of respiratory disease.

[4]  C Hendricks,et al.  Changes in inspiratory muscle electrical activity and upper airway resistance during periodic breathing induced by hypoxia during sleep. , 1987, The American review of respiratory disease.

[5]  R. Rogers,et al.  Patient compliance with nasal CPAP therapy for sleep apnea. , 1986, Chest.

[6]  T. Dick,et al.  Involvement of serotonin in the excitation of phrenic motoneurons evoked by stimulation of the raphe obscurus , 1986, The Journal of neuroscience : the official journal of the Society for Neuroscience.

[7]  T. Roth,et al.  Uvulopalatopharyngoplasty. One-year followup. , 1985, Chest.

[8]  T. Roth,et al.  Evaluation of the effectiveness of uvulopalatopharyngoplasty , 1985, The Laryngoscope.

[9]  T. Roth,et al.  Night-to-night consistency of apneas during sleep. , 1984, The American review of respiratory disease.

[10]  N. Cherniack,et al.  Responses to chemical stimulation of upper airway muscles diaphragm in awake cats. , 1984, Journal of applied physiology: respiratory, environmental and exercise physiology.

[11]  M. Kryger,et al.  The role of protriptyline in obstructive sleep apnea. , 1983, Bulletin europeen de physiopathologie respiratoire.

[12]  P. L. Smith,et al.  The effects of protriptyline in sleep-disordered breathing. , 1983, The American review of respiratory disease.

[13]  M. Kryger,et al.  Protriptyline in obstructive sleep apnea: a double-blind trial. , 1982, The New England journal of medicine.

[14]  N. Cherniack,et al.  Effect of chemical stimuli on nerves supplying upper airway muscles. , 1982, Journal of applied physiology: respiratory, environmental and exercise physiology.

[15]  T. Roth,et al.  Protriptyline in the treatment of sleep apnoea. , 1982, Thorax.

[16]  D. Walker,et al.  Effect of 5-hydroxytryptophan on electrocortical activity and breathing movements of fetal sheep. , 1981, American journal of obstetrics and gynecology.

[17]  T. Waldrop,et al.  Prolonged stimulation of respiration by endogenous central serotonin. , 1980, Respiration physiology.

[18]  G. Breese,et al.  An evaluation of the mechanism by which serotonergic activation depresses respiration. , 1980, The Journal of pharmacology and experimental therapeutics.

[19]  H. Boudoulas,et al.  Sleep apnea , 1979, Neurology.

[20]  G. Volgyesi,et al.  Diaphragmatic muscle tone. , 1979, Journal of applied physiology: respiratory, environmental and exercise physiology.

[21]  M. Leeds.  John Douglas Pickup. , 1977, Lancet.

[22]  H. Schmidt,et al.  Protriptyline: an effective agent in the treatment of the narcolepsy-cataplexy syndrome and hypersomnia. , 1977, The American journal of psychiatry.

[23]  P. Bradley,et al.  Actions and interactions of narcotic agonists and antagonists on brain stem neurones. , 1974, Brain research.

[24]  K. Fuxe,et al.  Pharmacological studies on a possible role of central noradrenaline neurons in respiratory control , 1973, The Journal of pharmacy and pharmacology.

[25]  G. Burrows,et al.  Plasma concentration of nortriptyline and clinical response in depressive illness. , 1972, Lancet.

[26]  L. Hösli,et al.  A comparison of the effects of monoamines on neurones of the bulbar reticular formation. , 1971, Brain research.

[27]  P. Bradley,et al.  Antagonism of 5‐hydroxytryptamine by LSD 25 in the central nervous system: a possible neuronal basis for the actions of LSD 25 , 1970, British journal of pharmacology.

[28]  M. Monnier,et al.  An activating mechanism in the ponto-bulbar raphe system of the rabbit. , 1970, Brain Research.

[29]  A. Rechtschaffen,et al.  A manual of standardized terminology, technique and scoring system for sleep stages of human subjects , 1968 .

[30]  H. Weissbach,et al.  Pharmacological studies with the serotonin precursor, 5-hydroxytryptophan. , 1958, The Journal of pharmacology and experimental therapeutics.