Drug Is Promising for Sleep Apnea

June 5, 2003 -- The dream of finding an effective drug for a potentially life-threatening sleep disorder finally may be reality.

The antidepressant Remeron significantly reduced sleep apnea symptoms in a small group of patients participating in a newly reported study.

While taking the drug, all 12 patients showed improvement in sleep scores commonly used in people with obstructive sleep apnea. They experienced half as many slowed or stopped breathing episodes during sleep, and there was a 28% reduction in the overall number of sleep disruptions.

The research was funded by Remeron manufacturer Organon, Inc., and presented in Chicago this week at the annual meeting of the Associated Professional Sleep Societies.

First Potential Drug Treatment

"We have been testing drug candidates for this disorder for well over 20 years, but this is the first time that a drug has shown a benefit of this size and consistency in sleep apnea patients," study researcher David W. Carley, PhD, tells WebMD.

More than 12 million Americans are believed to suffer from obstructive sleep apnea, although most have not been diagnosed. People with the condition may stop breathing hundreds of times a night, often for a minute or more. Loud snoring and daytime sleepiness are the most common symptoms, but sleep apnea can also lead to high blood pressure, heart disease, and stroke.

Obstructive sleep apnea is caused by the blockage of airflow from the nose to the mouth during sleep. The most common treatment for the condition is a machine that forces air into the nose to maintain an open airway passage and allow normal breathing to maintain oxygen levels. Known as continuous positive air pressure, or CPAP, the therapy is very effective, but many patients find sleeping in a mask or nasal prongs uncomfortable.

"(CPAP) definitely works, but it is inconvenient and hard to tolerate," Carley says. "Some patients won't even attempt it, and many more who do quickly give up."

Fewer Sleep Disturbances

The 12 obstructive sleep apnea patients in the study were treated with either high or low doses of Remeron or a placebo an hour before bedtime. They were then monitored throughout the night at a University of Illinois at Chicago sleep center after each of three seven-day treatment periods.

Disturbances such as arousal from sleep were significantly reduced among patients on the high dose of Remeron compared with placebo-treated patients. And episodes of stopped or slowed breathing were significantly diminished in both treatments compared with placebo.

Radulovacki says larger studies are needed to confirm the safety and effectiveness of the antidepressant among patients with the sleep disorder.

American Sleep Apnea Association executive director Christin Engelhart calls the findings intriguing, and agrees they deserve further study. But she adds that compliance with drug treatments may end up being no better than with the available mechanical treatment.

"Compliance with the CPAP machine is about 50% overall, which is comparable to the best treatments for many other conditions," she says. "But numerous studies show that education and patient support can increase that compliance rate tremendously."