sodium-oxybate and Sleep-Apnea-Syndromes

While the symptoms of narcolepsy are often amenable to treatment with sodium oxybate (SXB), the respiratory effects of long-term SXB treatment have not been systematically studied. Recent reports have implicated SXB with several cases of worsening sleep-related breathing disturbances and accidental death. In addition, these patients are at risk for obesity, which may aggravate co-morbid obstructive sleep apnea.. Based on a review of the literature and the clinical experience of the author, recommendations for the use of SXB in patients with sleep-disordered breathing have been developed.. Among narcolepsy patients with evidence of sleep disordered breathing during baseline polysomnography, SXB should be prescribed only to those patients who fully comply with nasal continuous positive airway pressure therapy. The respiratory status of other SXB-treated patients should be periodically evaluated with nocturnal oximetry.. Based on the currently available data, physicians prescribing SXB should remain vigilant for the possible development of sleep-disordered breathing during long-term treatment with SXB.

Topics: Adjuvants, Anesthesia; Drug Monitoring; Humans; Narcolepsy; Sleep Apnea Syndromes; Sleep, REM; Sodium Oxybate

Many patients with Parkinson disease (PD) have excessive daytime sleepiness and numerous nocturnal sleep abnormalities.. To determine the safety and efficacy of the controlled drug sodium oxybate in a multicenter, open-label, polysomnographic study in subjects with PD and sleep disorders. Design, Setting, and Patients Inclusion required an Epworth Sleepiness Scale (ESS) score greater than 10 and any subjective nocturnal sleep concern, usually insomnia. An acclimation and screening polysomnogram was performed to exclude subjects with sleep-disordered breathing. The following evening, subjects underwent another polysomnogram, followed by an evaluation with the Unified Parkinson Disease Rating Scale (UPDRS) while practically defined off ("off") PD medications, ESS (primary efficacy point), Pittsburgh Sleep Quality Inventory, and Fatigue Severity Scale. Subjects then started sodium oxybate therapy, which was titrated from 3 to 9 g per night in split doses (at bedtime and 4 hours later) across 6 weeks, and returned for subjective sleep assessments. They then returned at 12 weeks after initiating therapy for a third polysomnogram, an off-medication UPDRS evaluation, and subjective sleep assessments. Data are expressed as mean (SD).. We enrolled 38 subjects. At screening, 8 had sleep apnea (n = 7) or depression (n = 1). Twenty-seven of 30 subjects completed the study. Three dropped out owing to dizziness (n = 3) and concurrent depression (n = 1). The mean dose of sodium oxybate was 7.8 (1.7) g per night. The ESS score improved from 15.6 (4.2) to 9.0 (5.0) (P < .001); the Pittsburgh Sleep Quality Inventory score, from 10.9 (4.0) to 6.6 (3.9) (P < .001); and the Fatigue Severity Scale score, from 42.9 (13.2) to 36.3 (14.3) (P < .001). Mean slow-wave sleep time increased from 41.3 (33.2) to 78.0 (61.2) minutes (P = .005). Changes in off-medication UPDRS scores were not significant, from 28.4 (10.3) to 26.2 (9.6).. Nocturnally administered sodium oxybate improved excessive daytime sleepiness and fatigue in PD.. clinicaltrials.gov Identifier: NCT00641186.

Topics: Adjuvants, Anesthesia; Adult; Aged; Antiparkinson Agents; Dose-Response Relationship, Drug; Female; Humans; Male; Middle Aged; Parkinson Disease; Polysomnography; Sleep Apnea Syndromes; Sleep Initiation and Maintenance Disorders; Sleep Stages; Sleep Wake Disorders; Sodium Oxybate; Treatment Outcome

Sodium oxybate (GHB, Xyrem, Jazz Pharmaceuticals) is used to treat cataplexy in patients with narcolepsy. We report the case of a middle aged, normo-ponderal narcoleptic woman without risk factors who developed reversible sleep apnea and objective sleepiness when treated by sodium oxybate, with an apnea-hypopnea index (AHI) of 19.7 on sodium oxybate and AHI 4.8 without treatment. Despite a subjective improvement in vigilance, mean sleep latency on MWT decreased from 21 minutes to 8 minutes on sodium oxybate.

Topics: Adult; Cataplexy; Central Nervous System Depressants; Dose-Response Relationship, Drug; Drug Administration Schedule; Female; Follow-Up Studies; Humans; Narcolepsy; Nocturnal Myoclonus Syndrome; Polysomnography; Risk Assessment; Severity of Illness Index; Sleep Apnea Syndromes; Sodium Oxybate; Treatment Outcome

Gamma-hydroxybutyrate (GHB) is best known as a recreational depressant drug, whose use has also been implicated in drug facilitated sexual assault cases. It is also available as a therapeutic agent (Xyrem) used for the treatment of daytime sleepiness or cataplexy associated with narcolepsy. This is a report of a case of a 53-year-old woman undergoing treatment with Xyrem for narcolepsy. The decedent was also prescribed tramadol, gabapentin, cetirizine, modafinil, carisoprodol, and Xyrem. Toxicological analysis of the blood revealed GHB 165.6 mg/L, and 90.7 mg/L in the urine. Blood GHB concentrations in the range 156-260 mg/L have been reported to induce moderately sound sleep. The combined use of central nervous system depressant drugs, together with her problematic sleep apnea, and snoring (both contraindications for GHB use) were determined to have caused this subject's death. The manner of death was determined to be accidental.

Topics: Amines; Benzhydryl Compounds; Carisoprodol; Central Nervous System Depressants; Cetirizine; Cyclohexanecarboxylic Acids; Drug Interactions; Drug Therapy, Combination; Female; Forensic Toxicology; Gabapentin; gamma-Aminobutyric Acid; Gastrointestinal Contents; Humans; Middle Aged; Modafinil; Narcolepsy; Sleep Apnea Syndromes; Snoring; Sodium Oxybate; Tramadol; Vitreous Body

Topics: Automobile Driving; Central Nervous System Depressants; Drug Interactions; Drug Therapy, Combination; Forensic Toxicology; Humans; Obesity; Sleep Apnea Syndromes; Sodium Oxybate

Topics: Adjuvants, Anesthesia; Drug Therapy; Humans; Sleep Apnea Syndromes; Sodium Oxybate

The polygraphically recorded sleep-wake continuum of 21 Prader-Willi syndrome (PWS) patients was compared with that of 19 normal people. In the Prader-Willi group, excessive daytime sleepiness (EDS) is found in 95% of subjects, and rapid eye movement (REM) sleep disorders occur in 52%. These two features were significantly different from the normal group of subjects. No indications were found for the presence of the apnoea syndrome. The REM sleep disorders are: sleep onset rapid eye movements (SOREM), REM sleep in naps, many arousals during REM sleep, and a significant decrease in total REM sleep. These disturbances in the Prader-Willi group, combined with the presence of EDS and sometimes of cataplexy, are likely to be expressions of a narcoleptic syndrome although this was not sustained by the HLA-DR2 expression above normal. The quality of life of PWS subjects can be improved in some cases by treating them as narcoleptic patients.

Topics: Adolescent; Adult; Catalepsy; Clomipramine; Female; Humans; Hypoventilation; Imipramine; Male; Middle Aged; Narcolepsy; Polysomnography; Prader-Willi Syndrome; Sleep Apnea Syndromes; Sleep, REM; Sodium Oxybate

Sleep apneas are rarely observed during slow-wave sleep (SWS), which is poorly represented in patients with obstructive sleep apnea (OSA). Gamma-hydroxybutyrate (gamma OH), a natural metabolite of the brainstem, increases the percentage of total sleep time (TST) spent in SWS. We evaluated the effects of gamma OH on sleep and breathing disorders in eight patients with OSA (age, 45 +/- 2 yr; body mass index, 35.0 +/- 1.5 kg/m2; mean +/- SEM). Three conventional sleep studies were done within a week; the first and third were control studies, and the second was the gamma OH study (30 mg/kg at bedtime and 3 h later). Because the effects of the drug last only 3 h, we analyzed and compared the results of the first 6 h of sleep recording. The percentage of TST spent in SWS increased with gamma OH (30.7 +/- 3.9%) compared with that in the control studies (12.5 +/- 1.1 and 11.0 +/- 2.1%) at the expense of stages I and II. There was no difference between apnea index obtained during the control studies (26.3 +/- 5.3 and 25.4 +/- 6.2/h) and that obtained during the gamma OH study (29.6 +/- 4.9/h). Most apneic events occurred during Stages I and II, and REM, but this proportion was less during the gamma OH study (77.9 +/- 8.9%) than during the control studies (92.3 +/- 1.9 and 95.9 +/- 2.2%), apneas occurring even during SWS with gamma OH.(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Electroencephalography; Humans; Male; Middle Aged; Monitoring, Physiologic; Sleep Apnea Syndromes; Sleep Stages; Sodium Oxybate; Time Factors

Gammahydroxybutyrate was administered to a patient who experienced narcolepsy associated with central sleep apnea. The treatment relieved the major symptoms of narcolepsy, and significantly decreased the number of apneic periods. Gammahydroxybutyrate did not cause the prolonged and potentially fatal apneic periods associated with the use of other hypnotic agents.

Topics: Humans; Hydroxybutyrates; Male; Middle Aged; Narcolepsy; Sleep Apnea Syndromes; Sleep Stages; Sodium Oxybate