Sleep Apnea in Elderly
| Status: | Recruiting |
|---|---|
| Conditions: | Insomnia Sleep Studies, Pulmonary |
| Therapuetic Areas: | Psychiatry / Psychology, Pulmonary / Respiratory Diseases |
| Healthy: | No |
| Age Range: | 60 - 89 |
| Updated: | 4/6/2019 |
| Start Date: | July 3, 2015 |
| End Date: | December 30, 2019 |
| Contact: | Ruchi Rastogi, MSc |
| Email: | rrastogi@med.wayne.edu |
| Phone: | (313) 576-1000 |
Pathophysiology-Guided Therapy for Sleep Apnea in the Elderly
Sleep-disordered breathing (SDB or sleep apnea) is very common among elderly Veterans and
leads to increased morbidity and mortality in this population. The proposal aims to identity
whether oxygen, finasteride and acetazolamide can be effective in reducing unstable breathing
and eliminating sleep apnea in the elderly via different mechanisms. This proposal will
enhance the investigators' understanding of the pathways that contribute to the development
of sleep apnea in the elderly. The investigators expect that the results obtained from this
study will positively impact the health of Veterans by identifying new treatment modalities
for sleep apnea. A cumulative effect of the investigators' research will fulfill the
long-term goal of improving the quality of life of elderly Veterans suffering from sleep
apnea and its potential life-threatening complications.
leads to increased morbidity and mortality in this population. The proposal aims to identity
whether oxygen, finasteride and acetazolamide can be effective in reducing unstable breathing
and eliminating sleep apnea in the elderly via different mechanisms. This proposal will
enhance the investigators' understanding of the pathways that contribute to the development
of sleep apnea in the elderly. The investigators expect that the results obtained from this
study will positively impact the health of Veterans by identifying new treatment modalities
for sleep apnea. A cumulative effect of the investigators' research will fulfill the
long-term goal of improving the quality of life of elderly Veterans suffering from sleep
apnea and its potential life-threatening complications.
Sleep apnea-hypopnea syndrome (SAHS) has a high prevalence and is associated with adverse
cardiovascular consequences in elderly Veterans. Positive airway pressure therapy is deemed
cumbersome and often associated with non-adherence to therapy. This proposal will investigate
whether alternative therapies can be developed by modulating specific physiologic mechanisms
of ventilatory control. Specifically, the investigators will study whether interventions with
sustained hyperoxia (Aim 1), finasteride (Aim 2) and acetazolamide (Aim 3) will reduce
breathing instability during sleep by reducing chemoresponsiveness and/or increasing
cerebrovascular reactivity (CVR) in order to alleviate sleep disordered breathing in the
elderly with sleep apnea. The proposed aims will also allow us to delineate key mechanisms of
breathing instability in the elderly. The investigators envision that the results obtained
from this project will ultimately allow us to develop novel alternative therapies for sleep
apnea in the elderly. We will also compare CVR in young vs older adults
cardiovascular consequences in elderly Veterans. Positive airway pressure therapy is deemed
cumbersome and often associated with non-adherence to therapy. This proposal will investigate
whether alternative therapies can be developed by modulating specific physiologic mechanisms
of ventilatory control. Specifically, the investigators will study whether interventions with
sustained hyperoxia (Aim 1), finasteride (Aim 2) and acetazolamide (Aim 3) will reduce
breathing instability during sleep by reducing chemoresponsiveness and/or increasing
cerebrovascular reactivity (CVR) in order to alleviate sleep disordered breathing in the
elderly with sleep apnea. The proposed aims will also allow us to delineate key mechanisms of
breathing instability in the elderly. The investigators envision that the results obtained
from this project will ultimately allow us to develop novel alternative therapies for sleep
apnea in the elderly. We will also compare CVR in young vs older adults
Inclusion Criteria:
- Adults who are 60 years old and older, with mild to moderate sleep apnea with AHI >/=5
to 20/hr with central, obstructive, mixed apneas and hypopneas.
- For the finasteride protocol elderly men with above criteria will be enrolled.
Exclusion Criteria:
- Patients with severe sleep apnea (AHI>20/hr)
- Patients with history of prostate cancer
- Males with hypogonadism
- History of cardiac disease, including myocardial infarction
- Bypass surgery
- Atrial and ventricular tachy-bradycardias
- Systolic congestive heart failure and Cheyne-Stokes respiration
- Current unstable angina
- Stroke
- Schizophrenia
- Untreated hypothyroidism
- Seizure disorder
- Preexisting renal failure and liver disorders
- Failure to give informed consent.
- Patients with significant pulmonary diseases by history and abnormal pulmonary
function testing, including moderate obstructive/restrictive lung/chest wall disorders
with resting oxygen saturation of <96% or on supplemental oxygen
- Patients on certain medications including:
- study drugs
- sympathomimetics/parasympathomimetics or their respective blockers
- narcotics
- antidepressants
- anti-psychotic agents
- other central nervous system (CNS) altering medications
- current alcohol, tobacco or recreational drug use
- Patients with BMI>34kg/m2 will be excluded to avoid the effects of morbid obesity on
pulmonary mechanics and ventilatory control
- Elderly with unstable gait or mobility issues that may preclude safe participation
- Individuals with allergy to finasteride or acetazolamide will be excluded from the
specific protocol
- Pregnant women
We found this trial at
1
site
Detroit, Michigan 48201
Principal Investigator: Susmita Chowdhuri, MD
Phone: 313-576-4448
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