Obstructive Sleep Apnea
Conditions
Keywords
OSA, sleep apnea, pharmacological treatment, Drug treatment
Brief summary
This is an open-label trial that tests the effectiveness of Dronabinol in treating obstructive sleep apnea (OSA). All participants will take oral Dronabinol for two weeks. Sleep studies will be conducted before and after treatment to measure OSA severity.
Detailed description
Obstructive sleep apnea (OSA), is a serious respiratory disorder that involves repetitive cessation of breathing during sleep. It is estimated that 15-20 million people in the United States suffer from OSAS, which has been linked to increased risk for hypertension, heart failure, depression, and diabetes. The current standard of care for OSA, positive airway pressure (PAP), involves a mechanical device with low patient tolerance and adherence. Upper airway surgical approaches are also an option but are invasive and often unsuccessful. Effective drug treatments for OSA remain to be identified. This study will enroll up to 120 Veterans so that 45 Veterans may complete the two-week open-label Dronabinol treatment trials. The results of the study will be used to develop a prediction model for OSA severity reduction after 2-week Dronabinol treatment vs. pretreatment AHI. Participants clinical (age, sex, body mass index, comorbidity) and pretreatment polysomnographic characteristics (sleep architecture, respiratory disturbance, and endotypes; loop-gain, arousal threshold, upper airway collapsibility and compensation) will be used to develop a prediction model for improvement of OSA with Dronabinol treatment. This prediction model will be used for a randomized clinical trial after the completion of this trial.
Interventions
DRUGDronabinol
Open label Dronabinol treatment for two weeks.
Sponsors
VA Office of Research and Development
University of Illinois at Chicago
Study design
Allocation
NA
Intervention model
SINGLE_GROUP
Primary purpose
TREATMENT
Masking
NONE
Intervention model description
120 Veterans will be screened and enrolled to achieve 45 participants completing the study. All participants will receive oral Dronabinol treatment nightly for two weeks.
Eligibility
Sex/Gender
ALL
Age
No minimum to 65 Years
Healthy volunteers
No
Inclusion criteria
1\. AHI 15-50 per hour on pre-treatment polysomnography
Exclusion criteria
1. Positive Airway Pressure (PAP) treatment of OSA: use \> 4 hours per day for 30% of days within 3 months of enrollment. PAP use will be determined from device download data 2. Hypoglossal nerve stimulator (HNS) or oral appliance device treatment with use \> 4 hours per day for 30% of days within 3 months of enrollment. HNS use will be determined by device download and oral appliance use by self-report 3. History of upper airway surgery for OSA (except adenotonsillectomy) 4. Central or mixed apneas \>25% of respiratory events on diagnostic polysomnography 5. Arterial oxygen saturation \< 75% for \> 5% sleep time on pretreatment polysomnography 6. Body mass index \> 45 kg/m2 7. If post-bariatric surgery, weight must be stable ±5% (per electronic medical records) for at least 6 months before the first dose of the study drug 8. Active enrollment in a weight loss program 9. Shiftwork within 3 months of enrollment 10. High-risk occupation: commercial driver and pilot 11. Motor vehicle accident or near-miss incident within 1 year of enrollment 12. Current drug or habitual alcohol use or positive urine drug screen 13. Comorbid medical and psychiatric disorders: 1. Primary sleep disorders: e.g., narcolepsy, restless legs syndrome 2. Uncontrolled mood disorder or a diagnosis of schizophrenia 3. Initiation of new antidepressant or antipsychotic medication within 3 months 4. Identified as high-risk for suicide in electronic health records 5. Uncontrolled medical disorders (coronary heart disease, arrhythmia, congestive heart failure, chronic obstructive pulmonary disease, chronic hypoxemic or hypercapnic respiratory failure, stroke within 6 months of enrollment, chronic liver or kidney disease, autoimmune disorders) 14. Use of sedative-hypnotic medications within 30 days of enrollment 15. Complete blood count or liver function test values more than 1.5 times the upper limit of normal 16. Pregnancy 17. Allergy to cannabinoids or sesame oil 18. Average weekly alcohol consumption of more than 10 servings 19. Participation in other investigational protocols within 30 days of enrollment
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Apnea hypopnea index (AHI) | 2 weeks | The change in AHI after two weeks of Dronabinol treatment will be determined from before and after treatment polysomnograms. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| T<90 | 2 weeks | The change in time below 90% oxygen saturation (T\<90) after two weeks of Dronabinol treatment will be determined from before and after treatment polysomnograms. |
Countries
United States
Contacts
CONTACTBharati Prasad, MD
CONTACTKaren M Lenehan
PRINCIPAL_INVESTIGATORBharati Prasad, MD
Jesse Brown VA Medical Center, Chicago, IL
Outcome results
None listed