Circadian rhythms in obstructive sleep apnea syndrome: Augmentation of the effect of CPAP therapy with adjuvant melatonin administration.
Item
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Title
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Circadian rhythms in obstructive sleep apnea syndrome: Augmentation of the effect of CPAP therapy with adjuvant melatonin administration.
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Identifier
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AAI9808030
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identifier
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9808030
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Creator
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Zozula, Rochelle.
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Contributor
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Adviser: Arthur J. Spielman
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Date
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1997
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Language
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English
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Publisher
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City University of New York.
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Subject
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Psychology, Experimental | Health Sciences, Medicine and Surgery
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Abstract
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Obstructive sleep apnea syndrome (OSAS) is associated with chronic sleep fragmentation due to repetitive arousals which occur in response to upper airway occlusion. Sleep disruption plays a role in the pathogenesis in many of the consequences of OSAS, including excessive daytime sleepiness, cognitive and personality changes, cardiovascular alterations, and sexual dysfunction. Nocturnal temperature rhythm disturbances are evidenced in OSAS and appear to be related to chronic sleep fragmentation and disrupted sleep architecture.;Nasal continuous positive airway pressure (CPAP) is the non-surgical treatment of choice for OSAS. CPAP is associated with improvement in sleep and respiratory parameters. However, many patients evidence persistent daytime dysfunction. Proposed explanations include: inadequate sleep duration, continued sleep fragmentation due to suboptimal treatment, or irreversible anoxic brain damage. It is hypothesized that chronic sleep fragmentation in OSAS contributes to nocturnal temperature rhythm disturbance, which does not resolve with acute CPAP treatment, and is reflected by continued daytime deficits. It was hypothesized that lowering body temperature at sleep onset by bedtime administration of melatonin, with CPAP, would stabilize sleep patterns by reducing arousal, leading to enhanced daytime performance.;This study utilized a pre/post randomized treatment design, with double-blind administration of melatonin or placebo. OSAS subjects were age- and sex-matched to individuals without sleep complaints. Body temperature, sleep, respiration, and daytime functioning were assessed before and after two weeks of continuous treatment. Measures of sleep fragmentation, respiratory disturbance and temperature were used to predict the severity of the apneic disorder and subsequent treatment response.;The OSAS group showed decreased nocturnal temperature rhythm amplitude before treatment compared to controls, with significant improvement noted following treatment. Sleep fragmentation, respiration and daytime sleepiness/alertness were markedly altered in the OSAS group before treatment. Melatonin did not augment the effect of CPAP with regard to temperature amplitude or sleep parameters. Performance on the Four-Choice Reaction Time Task was significantly improved in the OSAS group following treatment. Post-treatment MWT values were reduced in the group receiving melatonin compared to the placebo group. While sleep fragmentation and respiratory parameters had prognostic value, temperature measures bore little to no relationship with daytime performance measures.
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Type
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dissertation
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Source
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PQT Legacy CUNY.xlsx
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degree
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Ph.D.
