Trazodone improves obstructive sleep apnea after ischemic stroke: a randomized, double-blind, placebo-controlled,...

Area of Science:

• Neurology
• Sleep Medicine
• Pharmacology

Background:

• Obstructive sleep apnea (OSA) pathogenesis is linked to low arousal threshold, potentially treatable with sedatives.
• Stroke patients frequently experience insomnia and depression, often treated with sedative antidepressants.
• The impact of sedative antidepressants on OSA severity in stroke patients remains understudied.

Purpose of the Study:

• To investigate the effect of trazodone on obstructive sleep apnea (OSA) severity in patients who have experienced an ischemic stroke.
• To evaluate trazodone's impact on sleep architecture, particularly slow-wave sleep, and respiratory parameters in stroke patients with OSA.

Main Methods:

• A double-blinded, randomized crossover pilot study involving 22 post-acute ischemic stroke patients with OSA.
• Participants received either 100 mg of trazodone or a placebo before polysomnography, with a washout period of approximately one week.
• Baseline heart rate variability and 24-hour ambulatory blood pressure were also measured.

Main Results:

• Trazodone administration significantly increased slow-wave sleep duration (31.5% vs. 18.4%, P < 0.001).
• Significant improvements were observed in OSA severity parameters, including the apnea-hypopnea index (AHI) (25.4 vs. 39.1 events/h, P < 0.001) and respiratory arousal index (P < 0.001).
• Minimum oxygen saturation improved (80.2% vs. 77.1%, P = 0.016), and responders showed reduced sympathetic tone.

Conclusions:

• Obstructive sleep apnea in patients with comorbid ischemic stroke may represent a distinct phenotype.
• Trazodone effectively decreases OSA severity in this patient group without exacerbating nocturnal hypoxia.
• This study suggests trazodone is a potential therapeutic option for managing OSA in stroke survivors.