Influence of Low-Dose Doxepin on Periodic Leg Movements in Sleep in Primary Insomnia Patients. Einfluss von niedrig-dosiertem Doxepin auf die periodischen Beinbewegungen im Schlaf bei Patienten mit primarer Insomnie

Abstract

Question of the study As sedating antidepressants have been used increasingly in the treatment of insomnia, the question whether they elicit periodic leg movements in sleep (PLMS) and thereby disturb sleep patterns may be clinically relevant. PLMS are generally supposed to play a role in eliciting and maintaining sleep disturbances in patients with otherwise unexplained insomnia or daytime sleepiness. We evaluated the PLMS data from a double-blind, placebo-controlled polysomnographic treatment study with doxepin in patients with primary insomnia. The aim of the study was to investigate the influence of low-dose doxepin on PLMS. Patients and methods PLMS recordings from the first diagnostic nights were scored in all 40 patients. PLMS scores from each of the 10 polysomnographic (PSG) nights were however available only in a subset of subjects, because PLMS data were originally not considered as a study objective. The PLMS data of 13 patients over 10 nights (2 baseline nights, 3 treatment nights, 3 withdrawal nights, 2 follow-up nights) were assessed. Patients were treated either with doxepin (six patients 50 mg, one patient 25 mg) or with placebo (six patients) 1 h prior to bed time. Results Comparing the doxepin and the placebo group for the different days of the study, we found no significant differences in PLMS parameters. In the doxepin group, the discontinuation of doxepin was however associated with a significant (P < 0.05) decrease in the PLMS-arousal index (PLMS associated with arousal per hour of sleep), indicating a possible relationship between doxepin medication and the presence of PLMS. Conclusions Treatment with low-dose doxepin appears to exert only a weak influence on PLMS in patients with primary insomnia. Keywords sleep -periodic leg movement -tricyclic antidepressant -treatment -primary insomnia ZusammenfassungFragestellung Sedierende Antidepressiva werden zunehmend in der Behandlung der Insomnien eingesetzt. Die Frage, ob sedierende Antidepressiva die Anzahl der PLMS erhöhen gewinnt daher an klinischer Relevanz, da PLMS zur Entstehung bzw. Aufrechterhaltung von Insomnien beitragen können. In der vorliegenden Untersuchung haben wir die PLMS-Daten einer bereits publizierten doppel-blinden plazebo-kontrollierten polysomnographischen (PSG) Behandlungsstudie mit niedrig-dosiertem Doxepin bei Patienten mit primärer Insomnie ausgewertet. Ziel der retrospektiven Auswertung war es, den Einfluss von niedrig-dosiertem Doxepin auf die Anzahl der PLMS zu untersuchen.