Hypnotics to Improve Polysomnography Yield: Eszopiclone vs Ramelteon?

Condition(s) targeted: Obstructive Sleep Apnea

Intervention: Rozerem (Ramelteon) (Drug); Lunesta (Eszopiclone) (Drug); Placebo (Drug)

Phase: N/A

Status: Recruiting

Sponsored by: Southern California Institute for Research and Education

Official(s) and/or principal investigator(s):
Catherine S. Sassoon, MD, Principal Investigator, Affiliation: VA Long Beach Healthcare System

Overall contact:
Catherine S. Sassoon, MD, Phone: (562) 826-5839, Email: catherine.sassoon@va.gov

This study is being conducted to determine if eszopiclone is as effective as ramelteon when used as a pre-medication (sleeping pill) in sleep studies performed to diagnose and treat sleep apnea.

Official title: Hypnotics to Improve Polysomnography Yield: Eszopiclone vs Ramelteon?

Study design: Diagnostic, Randomized, Double Blind (Subject, Investigator), Placebo Control, Parallel Assignment, Safety/Efficacy Study

Primary outcome: Non-usable and poor quality PSGs and CPAP intolerance

Detailed description: Many Veterans suffer from sleep disordered breathing with a high prevalence of undiagnosed obstructive sleep apnea. One test that can be effective in the diagnosis of sleep apnea is the polysomnogram (PSG). Split-night PSG consists of a diagnostic phase in the first half of the night and a continuous positive airway pressure titration (CPAP) in the second half of the night. CPAP is the standard, most effective therapy for obstructive sleep apnea. Due to the unfamiliar sleep environment of the laboratory and instrumentation that must be used (application of electroencephalogram leads), patients are frequently not able to sleep adequately. In these cases, the PSG must be repeated. Oral hypnotic agents are often used as a pre-medication to increase the yield of PSG in an attempt to decrease the need for repeat studies.

Numerous data is available on the effects of premedication with oral short-acting hypnotics on PSG quality and efficacy of CPAP titration. In one study, eszopiclone, a nonbenzodiazepine gaba-receptor agonist short-acting hypnotic, has been shown to improve PSG quality and CPAP titration. Another short-acting hypnotic, ramelteon, was recently approved by FDA but the effects of ramelteon in improving PSG quality and efficacy of CPAP titration are unclear. The advantage of ramelteon over eszopiclone is the lack of drug dependency or abuse potential. This study aims to evaluate the efficacy of ramelteon compared to eszopiclone when administered prior to split-night PSG and CPAP titration.

Minimum age: 18 Years. Maximum age: 65 Years. Gender(s): Both.

Criteria:

Inclusion Criteria:

- Referred by VA Long Beach Sleep Clinic at their initial evaluation during outpatient

consultation for suspect obstructive sleep apnea.

Exclusion Criteria:

- Sleep disorders other than obstructive sleep apnea

- No prior PSG

- Uncontrolled medical condition

- Prior known adverse reaction to eszopiclone or ramelteon

- Liver disfunction

- Current alcohol abuser

- Current illicit drug abuser

- Alcohol consumption 12 hours prior to polysomnography

- Decompensated psychiatric disorders

- Severe dementia

- Concomitant use of benzodiazepines, trazodone, narcotics, barbiturates or other

medications with sedative or hypnotic effects

Catherine S. Sassoon, MD, Phone: (562) 826-5839, Email: catherine.sassoon@va.gov

VA Long Beach Healthcare System, Long Beach, California 90822-5201, United States; Recruiting
Catherine S. Sassoon, MD, Principal Investigator
Sterling Malish, MD, Sub-Investigator

Southern California Institute for Research and Education Website

Related publications:

Lettieri CJ, Quast TN, Eliasson AH, Andrada T. Eszopiclone improves overnight polysomnography and continuous positive airway pressure titration: a prospective, randomized, placebo-controlled trial. Sleep. 2008 Sep 1;31(9):1310-6.

Starting date: December 2008
Ending date: December 2009
Last updated: August 3, 2009