Sleep Apnea, Obstructive
Conditions
Keywords
Sleep apnea, obstructive, quetiapine, randomised, double-blind, placebo, respiratory arousal threshold
Brief summary
Quetiapine is medication used to treat schizophrenia and bipolar disorder. Increasingly, low doses of quetiapine are prescribed off-label for insomnia. Quetiapine increases sleep duration with fewer interruptions, and people report feeling more rested. This accounts for why it is popular to prescribe for insomnia. Insomnia and obstructive sleep apnea (OSA) share many symptoms and differential diagnosis can be difficult. While quetiapine may improve sleep and breathing in certain people (i.e in light sleepers) an initial study indicated that quetiapine caused breathing disturbances in healthy individuals. Effects in OSA are unknown. In this placebo-controlled double blind study, participants with mild-moderate OSA will spend 2 nights in the sleep lab, one with quetiapine at a dose commonly prescribed for insomnia and one with placebo. The investigators will assess participants sleep by standard clinical sleep study, and morning alertness using questionnaires, reaction tests, and a driving simulator test.
Interventions
DRUGQuetiapine 50 MG
A single dose of 50mg of quetiapine taken at bedtime for one night.
DRUGPlacebo
A placebo sugar pill that looks like the quetiapine tablet taken at bedtime for one night.
Sponsors
Flinders University
Study design
Allocation
RANDOMIZED
Intervention model
CROSSOVER
Primary purpose
OTHER
Masking
QUADRUPLE (Subject, Caregiver, Investigator, Outcomes Assessor)
Intervention model description
Double-blind, randomized, placebo-controlled, cross-over study
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* Ages: 18+ (Adult, Older Adult) * Gender: All * Moderate or more difficulty staying asleep score on the Insomnia Severity Index questionnaire * Obstructive Sleep Apnoea (OSA), Apnoea Hypopnea Index ≥ 5 events/hour * BMI between 18.5 and 40 kg/m2
Exclusion criteria
* Concomitant medications that interact or are contraindicated with quetiapine * Concomitant medications known to influence breathing, sleep, arousal, or muscle physiology * Current pregnancy or breast-feeding * Current or recent other medical conditions likely to affect results or safety
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Change in OSA severity (Quetiapine night vs. placebo night) | Two non-consecutive single night sleep studies (Quetiapine night vs. placebo night) up to one month apart. | OSA severity as measured by the AHI (apnoea hypopnea index measured as # events/h sleep) during overnight in-laboratory polysomnography. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Change in mean overnight hypoxemia (Quetiapine night vs. placebo night) | Two non-consecutive single night sleep studies (Quetiapine night vs. placebo night) up to one month apart. | Mean overnight oxygen saturation during sleep (%) measured via pulse oximetry during overnight in-laboratory polysomnography. |
| Change in time below 90% blood arterial oxygen saturation (Quetiapine night vs. placebo night) | Two non-consecutive single night sleep studies (Quetiapine night vs. placebo night) up to one month apart. | Percent time asleep spent below an arterial oxygen saturation of 90% measured via pulse oximetry during overnight in-laboratory polysomnography. |
| Change in sleep efficiency (Quetiapine night vs. placebo night) | Two non-consecutive single night sleep studies (Quetiapine night vs. placebo night) up to one month apart. | Percent time spent asleep divided by the recording time from lights out to lights on during overnight in-laboratory polysomnography. |
| Change in arousal index (Quetiapine night vs. placebo night) | Two non-consecutive single night sleep studies (Quetiapine night vs. placebo night) up to one month apart. | Number of cortical arousals per hour of sleep during overnight in-laboratory polysomnography. |
| Change in sleep architecture (Quetiapine night vs. placebo night) | Two non-consecutive single night sleep studies (Quetiapine night vs. placebo night) up to one month apart. | Proportion of sleep stages (% total sleep time) during overnight in-laboratory polysomnography. |
| Change in respiratory control (Quetiapine night vs. placebo night) | Two non-consecutive single night sleep studies (Quetiapine night vs. placebo night) up to one month apart. | Loop gain and the ventilatory response to arousal (% eupnea) during overnight in-laboratory polysomnography. |
| Change in nadir overnight hypoxemia (Quetiapine night vs. placebo night) | Two non-consecutive single night sleep studies (Quetiapine night vs. placebo night) up to one month apart. | Nadir overnight oxygen saturation during sleep (%) measured via pulse oximetry during overnight in-laboratory polysomnography. |
| Change in airway collapsibility (Quetiapine night vs. placebo night) | Two non-consecutive single night sleep studies (Quetiapine night vs. placebo night) up to one month apart. | Vpassive (% eupnea) during overnight in-laboratory polysomnography. |
| Change in pharyngeal muscle response (Quetiapine night vs. placebo night) | Two non-consecutive single night sleep studies (Quetiapine night vs. placebo night) up to one month apart. | Vcompensation (% eupnea) during overnight in-laboratory polysomnography. |
| Baseline OSA endotypes (outcomes 8-11) and whether they are associated with changes in OSA severity (Quetiapine night vs. placebo night) | Baseline sleep study | Exploratory analysis to determine if baseline OSA endotypes (outcomes 8-11) are associated with changes in OSA severity (Quetiapine night vs. placebo night) |
| Change in perceived sleepiness (Quetiapine night vs. placebo night) | Next morning following two non-consecutive single night sleep studies (Quetiapine night vs. placebo night) up to one month apart. | Next day perceived sleepiness assessed via the Karolinska Sleepiness Scale (10 point scale where 1=extremely alert and 10=extremely sleepy) |
| Change in driving simulator performance (Quetiapine night vs. placebo night) | Next morning following two non-consecutive single night sleep studies (Quetiapine night vs. placebo night) up to one month apart. | Next day alertness as measured via the AusEd driving simulator performance task |
| Change in psycho-motor vigilance (Quetiapine night vs. placebo night) | Next morning following two non-consecutive single night sleep studies (Quetiapine night vs. placebo night) up to one month apart. | Next day alertness as measured via the pschomotor vigilance test (PVT) |
| Change in the respiratory arousal threshold (Quetiapine night vs. placebo night) | Two non-consecutive single night sleep studies (Quetiapine night vs. placebo night) up to one month apart. | Threshold to arousal (% eupnea) during overnight in-laboratory polysomnography. |
Countries
Australia
Outcome results
None listed