Efficacy of Mirtazapine in Obstructive Sleep Apnea Syndrome

Carley, David W.; Olopade, Christopher O.; Ruigt, G.S.F.; Radulovački, Miodrag

doi:10.1093/sleep/30.1.35

Cited by 111 publications

(63 citation statements)

References 32 publications

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“…[30][31][32] In this study, we found that a single 15-mg dose of MIR caused sedation for up to 60 minutes after administration, which is consistent with previous results that indicate that the dose of MIR is an important factor in its ability to improve sleep. 29 MIR given in low doses at the onset of treatment has been reported to increase sleep duration in patients with major depression, which suggests that the ability of low-dose MIR to promote sleep may be caused by sedation-related side effects.…”

Section: Experiments 1: Effect Of Acute Mir Dosing On Sedationsupporting

confidence: 92%

Chronic dosing with mirtazapine does not produce sedation in rats

Salazar-Juárez

Barbosa-Méndez

Merino-Reyes

et al. 2017

Rev. Bras. Psiquiatr.

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Objective: Sedation/somnolence are major side effects of pharmacotherapies for depression, and negatively affect long-term treatment compliance in depressed patients. Use of mirtazapine (MIR), an atypical antidepressant approved for the treatment of moderate to severe depression with comorbid anxiety disorders, is associated with significant sedation/somnolence, especially in short-term therapy. Nonetheless, studies with human subjects suggest that MIR-induced sedation is transient, especially when high and repeated doses are used. The purpose of this study was to explore the effects of acute and chronic administration of different doses of MIR on sedation in the rat. Methods: Assessment of sedation was carried out behaviorally using the rotarod, spontaneous locomotor activity, and fixed-bar tests. Results: A 15-mg/kg dose of MIR induced sedative effects for up to 60 minutes, whereas 30 mg/kg or more produced sedation within minutes and only in the first few days of administration. Conclusion: These results suggest that 30 mg/kg is a safe, well-tolerated dose of MIR which generates only temporary sedative effects.

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Section: Experiments 1: Effect Of Acute Mir Dosing On Sedationsupporting

confidence: 92%

Chronic dosing with mirtazapine does not produce sedation in rats

Salazar-Juárez

Barbosa-Méndez

Merino-Reyes

et al. 2017

Rev. Bras. Psiquiatr.

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“…Trazodone, at least in theory, has the opposite effect on the upper airway musculature because of its central serotoninergic effect, as suggested by VEASEY et al [18]. Other drugs with serotoninergic activity, such as fluoxetine, mirtazapine and paroxetine, have been tested with some success in animals, although only limited success has been reported in humans, potentially due to minimal effects on the arousal threshold [15,[19][20][21][22][23].…”

Section: Discussionmentioning

confidence: 99%

Trazodone increases arousal threshold in obstructive sleep apnoea

Heinzer¹,

White²,

Jordan³

et al. 2008

Eur Respir J

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A low arousal threshold is believed to predispose to breathing instability during sleep. The present authors hypothesised that trazodone, a nonmyorelaxant sleep-promoting agent, would increase the effort-related arousal threshold in obstructive sleep apnoea (OSA) patients.In total, nine OSA patients, mean¡SD age 49¡9 yrs, apnoea/hypopnoea index 52¡32 events?h -1 , were studied on 2 nights, one with trazodone at 100 mg and one with a placebo, in a double blind randomised fashion. While receiving continuous positive airway pressure (CPAP), repeated arousals were induced: 1) by increasing inspired CO 2 and 2) by stepwise decreases in CPAP level. Respiratory effort was measured with an oesophageal balloon. End-tidal CO 2 tension (PET,CO 2 ) was monitored with a nasal catheter.During trazodone nights, compared with placebo nights, the arousals occurred at a higher PET,CO 2 level (mean¡SD 7.30¡0.57 versus 6.62¡0.64 kPa (54.9¡4.3 versus 49.8¡4.8 mmHg), respectively). When arousals were triggered by increasing inspired CO 2 level, the maximal oesophageal pressure swing was greater (19.4¡4.0 versus 13.1¡4.9 cmH 2 O) and the oesophageal pressure nadir before the arousals was lower (-5.1¡4.7 versus -0.38¡4.2 cmH 2 O) with trazodone. When arousals were induced by stepwise CPAP drops, the maximal oesophageal pressure swings before the arousals did not differ.Trazodone at 100 mg increased the effort-related arousal threshold in response to hypercapnia in obstructive sleep apnoea patients and allowed them to tolerate higher CO 2 levels.

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“…Mirtazapine is an antidepressant that has mixed profile serotonin agonist/antagonist [19]. Carely et al reported on two trials with mirtazapine to treat OSA.…”

Section: Pharmacotherapiesmentioning

confidence: 99%

“…Mirtazapine caused weight gain and lethargy in their trials. Therefore, mirtazapine is not recommended for the treatment of OSA [19,20].…”

Section: Pharmacotherapiesmentioning

confidence: 99%