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Can Improving Sleep Influence Sleep-Disordered Breathing?

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Abstract

Sleep-disordered breathing (SDB) encompasses a group of disorders that include obstructive sleep apnoea (OSA), central sleep apnoea (CSA) and nocturnal hypoventilation. SDB commonly coexists with sleep disorders such as insomnia and restless legs syndrome, and sleep deprivation has been shown to play a role in the pathogenesis of SDB. Participants of a workshop, held at the 6th annual meeting of The International Sleep Disorders Forum: The Art of Good Sleep in 2008, evaluated whether the effective management of sleep disorders could result in a reduction in SDB. Following the workshop, a critical review of the literature in the field of sleep and SDB was conducted in order to assess the impact of improving sleep on SDB, and to determine whether measures taken to improve sleep result in a subsequent improvement in SDB. Results showed that studies evaluating the influence of improved sleep on respiratory abnormalities in patients with SDB are lacking. Studies in patients with OSA, with or without obesity-hypoventilation syndrome, show that therapy with continuous positive airways pressure and non-invasive ventilation improves sleep parameters with beneficial effects on SDB. Studies involving small numbers of patients have shown that the antidepressants fluoxetine and mirtazapine produce improvements in sleep parameters and the apnoea-hypopnoea index, and that acetazolamide may improve CSA. The benzodiazepines flurazepam, temazepam and nitrazepam, the hypnotic zolpidem, the melatonin receptor agonist ramelteon and gamma-hydroxybutyrate have all been shown to improve sleep, but are not associated with reductions or worsening in SDB. It is clear that there is a distinct knowledge gap with regard to the benefit of improving sleep disturbances for subsequent improvements in SDB. Randomized controlled clinical trials investigating the effect of pharmacological and non-pharmacological improvement of sleep disorders focusing on whether there is improvement in coexisting OSA/SDB are clearly needed. Furthermore, well-designed clinical trials investigating the role of hypnotic agents in improving SDB in certain phenotypes will enable the development of treatment recommendations for primary care physicians managing these patients in routine clinical practice.

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Acknowledgements

The discussions that took place during a workshop at the 6th annual meeting of The International Sleep Disorders Forum: The Art of Good Sleep, held in 2008, contributed to the preparation of this article. The author would like to thank the following individuals who attended the workshop and contributed to the discussions that have informed the content of this article: Michel Billiard (France), Fabio Cirignotta (Italy), Martin Cohn (USA), Derk-Jan Dijk (UK), Diego Garcia-Borreguero (Spain), Ronald Grunstein (Australia), Gilles Lavigne (Canada), Liborio Parrino (Italy), Patrick Levy (France) and Peretz Lavie (Israel). The author would also like to thank Anna Battershill and Julian Martins from Wolters Kluwer Pharma Solutions for providing medical writing support in the preparation of this article. This assistance was supported by sanofi-aventis. The International Sleep Disorders Forum: The Art of Good Sleep 2008 was funded by sanofi-aventis.

Declaration of conflicts of interest: Frédéric Sériès declares no conflicts of interest, and received no honoraria for the writing of this paper.

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  1. Centre de Pneumologie, Institut Universitaire de cardiologie et de pneumologie de Québec, Québec, Québec, G1V 4G5, Canada

    Frédéric Sériès

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Sériès, F. Can Improving Sleep Influence Sleep-Disordered Breathing?. Drugs 69 (Suppl 2), 77–91 (2009). https://doi.org/10.2165/11532000-000000000-00000

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