Clinical Pharmacology in Sleep Medicine

Proctor, Ashley R.; Bianchi, Matt T.

doi:10.5402/2012/914168

Cited by 41 publications

(23 citation statements)

References 59 publications

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“…About half of people who seek treatment for poor sleep will receive a drug prescription, usually a hypnotic, anxiolytic benzodiazepine, or a serotonergic antidepressant (35), that will have varying efficacy and often uncertain safety with long-term use (6,25,28). Many people who do not seek treatment purchase over-the-counter sleep aids or use alcohol to get to sleep at night, which then disrupts sleep during the night (33). The cumulative evidence suggests that regular exercise may compare favorably with other behavioral options (6) for successful management of sleep disturbance.…”

Section: Introductionmentioning

confidence: 99%

Decline in Cardiorespiratory Fitness and Odds of Incident Sleep Complaints

Dishman

Sui

Church

et al. 2015

Medicine &Amp; Science in Sports &Amp; Exercise

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Purpose To examine longitudinal change in cardiorespiratory fitness and odds of incident sleep problems. Methods A cohort of 7368 men and 1155 women, aged 20–85 years, from the Aerobics Center Longitudinal Study. The cohort did not complain of sleep problems, depression, or anxiety at their first clinic visit. Cardiorespiratory fitness assessed at 4 clinic visits between 1971–2006, each separated by an average of 2–3 years, was used as a proxy measure of cumulative physical activity exposure. Sleep complaints were made to a physician during follow-up. Results Across visits, there were 784 incident cases of sleep complaints in men and 207 cases in women. After adjustment for age, time between visits, body mass index, smoking, alcohol use, chronic medical conditions, complaints of depression or anxiety at each visit, and fitness at Visit 1, each minute decline in treadmill endurance (i.e., a decline in cardiorespiratory fitness of approximately one-half MET) between ages 51 to 56 increased the odds of incident sleep complaints by 1.7% (1.0–2.4%) in men and 1.3% (0.0–2.8%) in women. Odds were ~8% higher per minute decline in people with sleep complaints at 2 or 3 visits. Conclusion The results indicate that maintenance of cardiorespiratory fitness during middle-age, when decline in fitness typically accelerates and risk of sleep problems is elevated, helps protect against the onset of sleep complaints made to a physician.

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Section: Introductionmentioning

confidence: 99%

Decline in Cardiorespiratory Fitness and Odds of Incident Sleep Complaints

Dishman

Sui

Church

et al. 2015

Medicine &Amp; Science in Sports &Amp; Exercise

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“…Although safe, the use of modafinil for the clinical treatment of ES in patients with narcolepsy must always be preceded by a very careful and complete clinical and complementary evaluation for the definition of the diagnostic and therapeutical indication. The clinical follow-up of these patients during the use of modafinil must be intensive and the side effects must be closely scrutinized [8] .…”

Section: Discussionmentioning

confidence: 99%

Cataplexy as a side effect of modafinil in a patient without narcolepsy

et al. 2014

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Narcolepsy is a disease in which there is diurnal excessive sleepiness with sleep attacks and a prevalence in the general population of 1/4000 individuals. Classically, it is characterized by cataplexy, sleep paralysis, hypnagogic hallucinations and fragmented sleep. The use of modafinil in the treatment of narcolepsy is the first option of treatment for diurnal excessive sleepiness.Although considered a safe drug for use in patients with narcolepsy, being utilized for more than 20 years, modafinil possesses a series of side effects, some of them still not fully researched or described.Side effects such as headache, nausea, anxiety, insomnia, lumbago, diarrhea, dyspepsia, rhinitis and vertigo are the most frequent. However, the clinical follow-up of patients under treatment with modafinil must be intensive and the side effects ought to be noted and evaluated. The under-response to treatment or the unexpected side effects must always be directed to differential diagnostics.The objective of this article is to describe an unexpected side effect of the use of modafinil in a patient with incorrect diagnosis of narcolepsy.

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“…Low doses of doxepin are FDA-approved to treat insomnia by promoting sleep onset (Goforth, 2009). Other sedating antidepressant and antipsychotic medications are more and more commonly prescribed "off-label" as sleeping pills (Proctor and Bianchi, 2012;Krystal et al, 2013). Apart from H1 and muscarinic ACh receptors, some of these agents (e.g., mirtazapine) have high affinity for 5-HT2A and adrenergic α1 receptors.…”

Section: Insomnia Disordermentioning

confidence: 99%

Clinical and Experimental Human Sleep-Wake Pharmacogenetics

Landolt

Holst

Valomon

2018

Sleep-Wake Neurobiology and Pharmacology

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Sleep and wakefulness are highly complex processes that are elegantly orchestrated by finetuned neurochemical changes among neuronal and non-neuronal ensembles, nuclei, and networks of the brain. Important neurotransmitters and neuromodulators regulating the circadian and homeostatic facets of sleep-wake physiology include melatonin,-aminobutyric acid, hypocretin, histamine, norepinephrine, serotonin, dopamine, and adenosine. Dysregulation of these neurochemical systems may cause sleep-wake disorders, which are commonly classified into insomnia disorder, parasomnias, circadian rhythm sleepwake disorders, central disorders of hypersomnolence, sleep-related movement disorders, and sleep-related breathing disorders. Sleep-wake disorders can have far-reaching consequences on physical, mental, and social well-being and health and, thus, need be treated with effective and rational therapies. Apart from behavioral (e.g., cognitive behavioral therapy for insomnia), physiological (e.g., chronotherapy with bright light), and mechanical (e.g., continuous positive airway pressure treatment of obstructive sleep apnea) interventions, pharmacological treatments often are the first-line clinical option to improve disturbed sleep and wake states. Nevertheless, not all patients respond to pharmacotherapy in uniform and beneficial fashion, partly due to genetic differences. The improved understanding of the neurochemical mechanisms regulating sleep and wakefulness and the mode of action of sleep-wake therapeutics has provided a conceptual framework, to search for functional genetic variants modifying individual drug response phenotypes. This article will summarize the currently known genetic polymorphisms that modulate drug sensitivity and exposure, to partly determine individual responses to sleep-wake pharmacotherapy. In addition, a pharmacogenetic strategy will be outlined how based upon classical and opto-/chemogenetic strategies in animals, as well as human genetic associations, circuit mechanisms regulating sleep-wake functions in humans can be identified. As such, experimental human sleep-wake pharmacogenetics forms a bridge spanning basic research and clinical medicine and constitutes an essential step for the search and development of novel sleep-wake targets and therapeutics.

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Clinical Pharmacology in Sleep Medicine

Cited by 41 publications

References 59 publications

Decline in Cardiorespiratory Fitness and Odds of Incident Sleep Complaints

Decline in Cardiorespiratory Fitness and Odds of Incident Sleep Complaints

Cataplexy as a side effect of modafinil in a patient without narcolepsy

Clinical and Experimental Human Sleep-Wake Pharmacogenetics

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