Effect of sertraline on breathing in depressed patients without moderate-to-severe sleep-related breathing disorders.

Abstract

Previous studies have reported that selective serotonin reuptake inhibitors (SSRIs) might improve sleep-related breathing disorders (SRBDs). However, the effects of SSRIs on breathing are not evaluated in subjects without moderate-to-severe SRBDs. Further, many symptoms of depression and SRBDs overlap, and so, it is interesting whether there are interactions between breathing and psychopathologic symptoms during SSRI treatment for depression. Data were taken from an open-label 8-week trial of sertraline in depressed patients with insomnia (n = 31). The depressed patients were administered 50mg sertraline at 8AM on the first day, and the dosage was subsequently titrated up to a maximum of 200mg/day during the 8-week trial. All the patients were tested by repeated polysomnography (PSG) (baseline, 1st day, 14th day, 28th day, and 56th day). Sleep-disordered breathing events were categorized as apneas, hypopneas, and respiratory event-related arousals (RERAs). The clinical responses and PSG characteristics improved continuously during the 8-week trial. From the 14th day on, the RERA index during all-night and non-rapid eye movement (NREM) sleep became stable and significantly higher than baseline and the first day (RERA index 7.3 ± 2.2 at baseline, 7.3 ± 2.5 on the 1st day, 4.4 ± 1.9 on the 14th day, 3.9 ± 1.3 on the 28th day, 4.2 ± 2.0 on the 56th day, F = 5.71, P = 0.02; NREM-RERA index 6.2 ± 2.0 at baseline, 6.3 ± 2.3 on the 1st day, 3.2 ± 1.5 on the 14th day, 3.5 ± 0.9 on the 28th day, 3.2 ± 1.7 on the 56th day, F = 4.92, P = 0.03). Additionally, the NREM-apnea index showed a similar pattern to that of the RERA index and reached a significant difference between baseline (1.0 ± 0.5) and the 14th day (0.5 ± 0.4) (KW = 4.28, P = 0.047). Compared to the no-improvement group, the improvement group with a decreasing score rate of the respiratory disturbance index (RDI) greater than or equal to -50% had a more positive decreasing score rate of slow wave sleep (SWS) (439.0 ± 78.2 vs 373.2 ± 77.9%, T = 3.46, P = 0.04) and a more negative decreasing score rate on the arousal index (-43.7 ± 16.7 vs -26.6 ± 9.7%, T = 9.16, P = 0.01), Pittsburgh Sleep Quality Index (PSQI) scores (-65.1 ± 33.7 vs -49.6 ± 21.4%, T = 4.74, P = 0.05), and Epworth Sleepiness Scale (ESS) scores (-55.7 ± 21.3 vs -36.4 ± 17.5%, T = 6.44, P = 0.02). This research indicates that SRBDs could be improved to some extent by sertraline treatment, which might be more common in patients with relatively more severe sleep-disordered breathing (e.g., RDI ≥ 10 in the current study). Although the sertraline-induced SRBD improvement seems not to have a significant clinical effect, the SRBD improvement group with decreasing score rate of RDI greater than or equal to -50% has better subjective and objective sleep aspects than the no-improvement group. Thus, the fact that the SRBDs' improvement was related to SSRIs might have a potential clinical benefit in the antidepressant treatment.