Case reportEffectiveness of mirtazapine in the treatment of sleep apnea/hypopnea syndrome (SAHS)
Introduction
Nasal continuous positive airway pressure (CPAP) is the best treatment for the SAHS at present, especially in patients with moderate to severe SAHS [1].
CPAP has been demonstrated to be effective controlling the symptoms and decreasing the apneas and hypopneas, but the acceptance and compliance by patients is only partial [2]. In addition, as there is increasing evidence linking this syndrome to cardiovascular and cerebrovascular complications [3], it is important to find alternative therapies for these patients.
Serotonin-enhancing drugs have been tested as pharmacological treatments for SAHS due to their potential to stimulate respiration; however, the improvement has been found to be poor. Carley and Radulovacki [4] used mirtazapine, an antidepressant with 5-HT1 agonist as well as 5-HT2 and 5-HT3 antagonist effect, in an animal model of central apnea, achieving a significant reduction of apneas during NREM and REM sleep.
Section snippets
Case report
We present a male patient, 82 years old, body mass index (BMI) of 24.4 kg/m2, with excessive daytime sleepiness and loud snoring over at least 10 years. An overnight PSG using standard wide criteria and including oronasal thermistor and nasal cannula pressure transducer (Alice 3; Healthdyne; Atlanta, GA) was performed in May 2002. This test revealed an apnea/hypopnea index of 54.9 events per hour of sleep (central apneas: 67; mixed apneas: 38; obstructive apneas: 6 and hypopneas: 18) (Table 1)
Discussion
It has been known for more than 25 years that central apneas can be seen in heavy snorers [5]; however, this case did show an unusually large number of central apneas. These central events are reduced by nasal CPAP; their underlying pathophysiology has been studied by Guilleminault et al. [6]. Schwartz and Rochemaure [7] reported improvement of obstructive apneas in Pickwickian patients using clomipramine, a tricyclic medication with aminergic reuptake blocking properties. Protriptyline was
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