Skip to main content
Top
Published in: Sleep and Breathing 1/2011

Open Access 01-01-2011 | Original Article

A 2-week, polysomnographic, safety study of sodium oxybate in obstructive sleep apnea syndrome

Authors: Charles F. P. George, Neil Feldman, Yanping Zheng, Teresa L. Steininger, Susanna M. Grzeschik, Chinglin Lai, Neil Inhaber

Published in: Sleep and Breathing | Issue 1/2011

Login to get access

Abstract

Purpose

Sodium oxybate (SXB) is approved for cataplexy and excessive daytime sleepiness in narcolepsy. Obstructive sleep apnea syndrome (OSAS) affects ∼9–50% of narcoleptics. Effects of 2-week SXB administration on apnea–hypopnea index (AHI), oxygen saturation (SaO2), and sleep architecture were investigated in OSAS patients.

Methods

OSAS patients (n = 48) received 2-week SXB or placebo (PBO) treatment with polysomnography at baseline and day 14. The primary outcome measure was change from baseline in mean AHI. Secondary outcomes included changes from baseline in SaO2, and sleep architecture.

Results

Compared with PBO, SXB significantly increased reduction in mean AHI and obstructive apnea index with SXB (−0.8 ± 13.3 vs. −8.2 ± 10.0; p = 0.0327 and 3.54 ± 11.1 vs. −4.72 ± 7.7; p = 0.0054, respectively) and significantly increased change in slow wave sleep duration (5.2 ± 25.0 min vs. 29.4 ± 37.0 min; p = 0.0038). There were no differences between treatments in SaO2, central apneic events, or other measures. Adverse events, most commonly headache, were noted in nine of 27 (33%) and six of 23 (26%) patients receiving SXB and PBO, respectively.

Conclusions

Short-term use of 4.5 g/night SXB did not generate respiratory depressant effects in OSAS patients as measured by AHI, obstructive apnea events, central apneas, and SaO2. Extended use of SXB in higher therapeutic doses in OSAS has not been studied, and merits caution.
Literature
1.
go back to reference Laborit H (1964) Sodium 4-hydroxybutyrate. Int J Neuropharmacol 32:433–451CrossRef Laborit H (1964) Sodium 4-hydroxybutyrate. Int J Neuropharmacol 32:433–451CrossRef
3.
go back to reference Scharf MB, Baumann M, Berkowitz DV (2003) The effects of sodium oxybate on clinical symptoms and sleep patterns in patients with fibromyalgia. J Rheumatol 30:1070–1074PubMed Scharf MB, Baumann M, Berkowitz DV (2003) The effects of sodium oxybate on clinical symptoms and sleep patterns in patients with fibromyalgia. J Rheumatol 30:1070–1074PubMed
4.
go back to reference Mamelak M, Black J, Montplaisir J, Ristanovic R (2004) A pilot study on the effects of sodium oxybate on sleep architecture and daytime alertness in narcolepsy. Sleep 27:1327–1334PubMed Mamelak M, Black J, Montplaisir J, Ristanovic R (2004) A pilot study on the effects of sodium oxybate on sleep architecture and daytime alertness in narcolepsy. Sleep 27:1327–1334PubMed
5.
go back to reference Scrima L, Hartman PG, Johnson FH Jr, Thomas EE, Hiller FC (1990) The effects of γ-hydroxybutyrate on the sleep of narcolepsy patients: a double-blind study. Sleep 3:479–490 Scrima L, Hartman PG, Johnson FH Jr, Thomas EE, Hiller FC (1990) The effects of γ-hydroxybutyrate on the sleep of narcolepsy patients: a double-blind study. Sleep 3:479–490
6.
go back to reference Lammers GJ, Arends J, Declerck AC, Ferrari MD, Schouwink G, Troost J (1993) Gamma-hydroxybutyrate and narcolepsy: a double blind placebo controlled study. Sleep 16:216–220PubMed Lammers GJ, Arends J, Declerck AC, Ferrari MD, Schouwink G, Troost J (1993) Gamma-hydroxybutyrate and narcolepsy: a double blind placebo controlled study. Sleep 16:216–220PubMed
7.
go back to reference US Xyrem® Multicenter Study Group (2002) A randomized, double blind, placebo-controlled multicenter trial comparing the effects of three doses of orally administered sodium oxybate with placebo for the treatment of narcolepsy. Sleep 25:42–49 US Xyrem® Multicenter Study Group (2002) A randomized, double blind, placebo-controlled multicenter trial comparing the effects of three doses of orally administered sodium oxybate with placebo for the treatment of narcolepsy. Sleep 25:42–49
8.
go back to reference US Xyrem® Multicenter Study Group (2003) A 12-month, open-label, multi-center extension trial of orally administered sodium oxybate for the treatment of narcolepsy. Sleep 26:31–35 US Xyrem® Multicenter Study Group (2003) A 12-month, open-label, multi-center extension trial of orally administered sodium oxybate for the treatment of narcolepsy. Sleep 26:31–35
9.
go back to reference US Xyrem® Multicenter Study Group (2004) Sodium oxybate demonstrates long-term efficacy for the treatment of cataplexy in patients with narcolepsy. Sleep Med 5:119–123CrossRef US Xyrem® Multicenter Study Group (2004) Sodium oxybate demonstrates long-term efficacy for the treatment of cataplexy in patients with narcolepsy. Sleep Med 5:119–123CrossRef
10.
go back to reference Xyrem® International Study Group (2005) A double-blind, placebo-controlled, study demonstrates the nightly administration of sodium oxybate significantly improves excessive daytime sleepiness in narcolepsy patients taking concurrent stimulant medications. J Clin Sleep Med 1:391–397 Xyrem® International Study Group (2005) A double-blind, placebo-controlled, study demonstrates the nightly administration of sodium oxybate significantly improves excessive daytime sleepiness in narcolepsy patients taking concurrent stimulant medications. J Clin Sleep Med 1:391–397
11.
go back to reference Kleinschmidt S, Schellhase C, Mertzlufft F (1999) Continuous sedation during spinal anaesthesia: gamma-hydroxybutyrate vs. propofol. Eur J Anaesthesiol 16(1):23–30PubMed Kleinschmidt S, Schellhase C, Mertzlufft F (1999) Continuous sedation during spinal anaesthesia: gamma-hydroxybutyrate vs. propofol. Eur J Anaesthesiol 16(1):23–30PubMed
12.
13.
go back to reference Xyrem® (sodium oxybate) oral solution Prescribing Information (2005) Jazz Pharmaceuticals, Inc., Palo Alto Xyrem® (sodium oxybate) oral solution Prescribing Information (2005) Jazz Pharmaceuticals, Inc., Palo Alto
14.
go back to reference Santamaria J, Sansa G, Iranzo A (2007) Prevalence and clinical relevance of sleep apnea in narcolepsy. Sleep 30(Suppl):A224–A225 Santamaria J, Sansa G, Iranzo A (2007) Prevalence and clinical relevance of sleep apnea in narcolepsy. Sleep 30(Suppl):A224–A225
15.
go back to reference Bonakis A, Howard RS, Kosky C, Williams A (2008) A severely sleep deprived patient. J Clin Sleep Med 4:378–380PubMed Bonakis A, Howard RS, Kosky C, Williams A (2008) A severely sleep deprived patient. J Clin Sleep Med 4:378–380PubMed
16.
go back to reference Young T, Palta M, Dempsey J, Skatrud J, Weber S, Badr S (1993) The occurrence of sleep-disordered breathing among middle-aged adults. N Engl J Med 328:1230–1235PubMedCrossRef Young T, Palta M, Dempsey J, Skatrud J, Weber S, Badr S (1993) The occurrence of sleep-disordered breathing among middle-aged adults. N Engl J Med 328:1230–1235PubMedCrossRef
17.
go back to reference Peppard PE, Young T, Palta M, Dempsey J, Skatrud J (2000) Longitudinal study of moderate weight change and sleep-disordered breathing. JAMA 284:3015–3021PubMedCrossRef Peppard PE, Young T, Palta M, Dempsey J, Skatrud J (2000) Longitudinal study of moderate weight change and sleep-disordered breathing. JAMA 284:3015–3021PubMedCrossRef
18.
go back to reference Schwartz AR, Patil SP, Laffan AM, Polotsky V, Schneider H, Smith PL (2008) Obesity and obstructive sleep apnea: pathogenic mechanisms and therapeutic approaches. Proc Am Thorac Soc 5:185–192PubMedCentralPubMedCrossRef Schwartz AR, Patil SP, Laffan AM, Polotsky V, Schneider H, Smith PL (2008) Obesity and obstructive sleep apnea: pathogenic mechanisms and therapeutic approaches. Proc Am Thorac Soc 5:185–192PubMedCentralPubMedCrossRef
19.
go back to reference Schuld A, Hebebrand J, Geller F, Pollmacher T (2000) Increased body-mass index in patients with narcolepsy. Lancet 355:1274–1275PubMedCrossRef Schuld A, Hebebrand J, Geller F, Pollmacher T (2000) Increased body-mass index in patients with narcolepsy. Lancet 355:1274–1275PubMedCrossRef
20.
go back to reference Dahmen N, Bierbrauer J, Kasten M (2001) Increased prevalence of obesity in narcoleptic patients and relatives. Eur Arch Psychiatry Clin Neurosci 251:85–89PubMedCrossRef Dahmen N, Bierbrauer J, Kasten M (2001) Increased prevalence of obesity in narcoleptic patients and relatives. Eur Arch Psychiatry Clin Neurosci 251:85–89PubMedCrossRef
21.
go back to reference George CFP, Feldman N, Inhaber N, Steininger T, Grzeschik SG, Lai C, Zheng Y (2010) A Safety Trial of sodium oxybate in patients with obstructive sleep apnea: acute effects on sleep-disordered breathing. Sleep Med 11(1):38–42 George CFP, Feldman N, Inhaber N, Steininger T, Grzeschik SG, Lai C, Zheng Y (2010) A Safety Trial of sodium oxybate in patients with obstructive sleep apnea: acute effects on sleep-disordered breathing. Sleep Med 11(1):38–42
22.
go back to reference Johns MW (1991) A new method for measuring daytime sleepiness: the Epworth sleepiness scale. Sleep 14:540–545PubMed Johns MW (1991) A new method for measuring daytime sleepiness: the Epworth sleepiness scale. Sleep 14:540–545PubMed
23.
go back to reference American Academy of Sleep Medicine Task Force (1999) Sleep-related breathing disorders in adults: recommendations for syndrome definition and measurement techniques in clinical research. Sleep 22:667–689 American Academy of Sleep Medicine Task Force (1999) Sleep-related breathing disorders in adults: recommendations for syndrome definition and measurement techniques in clinical research. Sleep 22:667–689
24.
go back to reference Rechtschaffen A, Kales A (1968) A manual of standardized terminology, techniques and scoring system for sleep stages of human subjects. U.S. Public Health Service, U.S. Government Printing Office, Washington Rechtschaffen A, Kales A (1968) A manual of standardized terminology, techniques and scoring system for sleep stages of human subjects. U.S. Public Health Service, U.S. Government Printing Office, Washington
25.
go back to reference Zozula R, Rosen R (2001) Compliance with continuous positive airway pressure therapy: assessing and improving treatment outcomes. Curr Opin Pulm Med 7:391–398PubMedCrossRef Zozula R, Rosen R (2001) Compliance with continuous positive airway pressure therapy: assessing and improving treatment outcomes. Curr Opin Pulm Med 7:391–398PubMedCrossRef
26.
go back to reference Kryger MH, Roth T, Dement W (2005) Principles and practice of sleep medicine, 4th edn. Saunders, Philadelphia, pp 232–244CrossRef Kryger MH, Roth T, Dement W (2005) Principles and practice of sleep medicine, 4th edn. Saunders, Philadelphia, pp 232–244CrossRef
27.
go back to reference Sériès F, Sériès I, Cormier Y (1992) Effects of enhancing slow-wave sleep by gamma-hydroxybutyrate on obstructive sleep apnea. Am Rev Respir Dis 145:1378–1383PubMedCrossRef Sériès F, Sériès I, Cormier Y (1992) Effects of enhancing slow-wave sleep by gamma-hydroxybutyrate on obstructive sleep apnea. Am Rev Respir Dis 145:1378–1383PubMedCrossRef
28.
go back to reference Black JE, Ristanovic R, Mamelak M, Montplaisir J (2002) Effect of increasing doses of sodium oxybate on nocturnal oxygen saturation: preliminary findings. Sleep 25(Suppl):A474–A475 Black JE, Ristanovic R, Mamelak M, Montplaisir J (2002) Effect of increasing doses of sodium oxybate on nocturnal oxygen saturation: preliminary findings. Sleep 25(Suppl):A474–A475
29.
go back to reference Ristanovic R, Black J, Mamelak M, Montplaisir J (2002) Analysis of dose effects of sodium oxybate on nocturnal respiratory disturbances. Sleep 25(Suppl):A473–A474 Ristanovic R, Black J, Mamelak M, Montplaisir J (2002) Analysis of dose effects of sodium oxybate on nocturnal respiratory disturbances. Sleep 25(Suppl):A473–A474
30.
go back to reference Aarab G, Lobbezoo F, Hamburger HL, Naeije M (2009) Variability in the apnea-hypopnea index and its consequences for diagnosis and therapy evaluation. Respiration 77(1):32–37PubMedCrossRef Aarab G, Lobbezoo F, Hamburger HL, Naeije M (2009) Variability in the apnea-hypopnea index and its consequences for diagnosis and therapy evaluation. Respiration 77(1):32–37PubMedCrossRef
31.
go back to reference Bittencourt LR, Suchecki D, Tufik S, Peres C, Togeiro SM, Bagnato MC, Nery LE (2001) The variability of the apnoea-hypopnoea index. J Sleep Res 10(3):245–251PubMedCrossRef Bittencourt LR, Suchecki D, Tufik S, Peres C, Togeiro SM, Bagnato MC, Nery LE (2001) The variability of the apnoea-hypopnoea index. J Sleep Res 10(3):245–251PubMedCrossRef
32.
go back to reference Wittig RM, Romaker A, Zorick FJ, Roehrs TA, Conway WA, Roth T (1984) Night-to-night consistency of apneas during sleep. Am Rev Respir Dis 129(2):244–246PubMed Wittig RM, Romaker A, Zorick FJ, Roehrs TA, Conway WA, Roth T (1984) Night-to-night consistency of apneas during sleep. Am Rev Respir Dis 129(2):244–246PubMed
33.
go back to reference Pardi D, Black J (2006) Gamma-hydroxybutyrate/sodium oxybate: neurobiology, and impact on sleep and wakefulness. CNS Drugs 20:993–1018PubMedCrossRef Pardi D, Black J (2006) Gamma-hydroxybutyrate/sodium oxybate: neurobiology, and impact on sleep and wakefulness. CNS Drugs 20:993–1018PubMedCrossRef
34.
go back to reference Godbout R, Pivik RT (1982) EEG and behavioral effects of gamma-hydroxybutyrate in the rabbit. Life Sci 31:739–748PubMedCrossRef Godbout R, Pivik RT (1982) EEG and behavioral effects of gamma-hydroxybutyrate in the rabbit. Life Sci 31:739–748PubMedCrossRef
Metadata
Title
A 2-week, polysomnographic, safety study of sodium oxybate in obstructive sleep apnea syndrome
Authors
Charles F. P. George
Neil Feldman
Yanping Zheng
Teresa L. Steininger
Susanna M. Grzeschik
Chinglin Lai
Neil Inhaber
Publication date
01-01-2011
Publisher
Springer Berlin Heidelberg
Published in
Sleep and Breathing / Issue 1/2011
Print ISSN: 1520-9512
Electronic ISSN: 1522-1709
DOI
https://doi.org/10.1007/s11325-009-0320-0

Other articles of this Issue 1/2011

Sleep and Breathing 1/2011 Go to the issue
Live Webinar | 27-06-2024 | 18:00 (CEST)

Keynote webinar | Spotlight on medication adherence

Live: Thursday 27th June 2024, 18:00-19:30 (CEST)

WHO estimates that half of all patients worldwide are non-adherent to their prescribed medication. The consequences of poor adherence can be catastrophic, on both the individual and population level.

Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.

Prof. Kevin Dolgin
Prof. Florian Limbourg
Prof. Anoop Chauhan
Developed by: Springer Medicine
Obesity Clinical Trial Summary

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.

Developed by: Springer Medicine