- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT02703220
Sleep Apnea in Elderly
August 16, 2023 updated by: VA Office of Research and Development
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.
Study Overview
Status
Recruiting
Conditions
Intervention / Treatment
Detailed Description
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
Study Type
Interventional
Enrollment (Estimated)
100
Phase
- Phase 4
Contacts and Locations
This section provides the contact details for those conducting the study, and information on where this study is being conducted.
Study Contact
- Name: Ruchi Rastogi, MSc
- Phone Number: (313) 576-1000
- Email: ruchi.rastogi@va.gov
Study Locations
-
-
Michigan
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Detroit, Michigan, United States, 48201-1916
- Recruiting
- John D. Dingell VA Medical Center, Detroit, MI
-
Principal Investigator:
- Susmita Chowdhuri, MD
-
Contact:
- Edi Levi, MD
- Phone Number: 313-576-4451
- Email: edi.levi@va.gov
-
-
Participation Criteria
Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.
Eligibility Criteria
Ages Eligible for Study
60 years to 89 years (Adult, Older Adult)
Accepts Healthy Volunteers
Yes
Description
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
Study Plan
This section provides details of the study plan, including how the study is designed and what the study is measuring.
How is the study designed?
Design Details
- Primary Purpose: Other
- Allocation: Randomized
- Interventional Model: Crossover Assignment
- Masking: Single
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
---|---|
Experimental: Hyperoxia
Determine the effect of sustained hyperoxia overnight vs room air overnight on ventilatory control during sleep, including the apneic threshold, carbon-dioxide reserve and chemosensitivity measured via pressure support ventilation (PSV) during (non-rapid eye movement sleep) NREM sleep.
|
The ventilatory effects of brief hyperoxia will be assessed by analyzing control breaths on room air immediately preceding the hyperoxic exposure, and comparing with the primary end-point, nadir minute ventilation breath, immediately following the brief hyperoxic exposure
|
Experimental: Acetazolamide (ACZ)
Determine the effect of acetazolamide on cerebrovascular responsiveness to CO2 during wake and sleep.
Participants will receive oral ACZ therapy for 7 days prior to the experimental night, on the night of the study and the subsequent night when polysomnography (PSG) will be performed.
|
Participants with sleep apnea will ingest capsules containing either placebo or acetazolamide 500 mg twice a day for 5 days.
On the final 2 consecutive nights while still on ACZ, the investigators will perform i) physiology tests and ii) in-lab follow-up PSG.
|
Experimental: Finasteride
Determine the effect of oral finasteride therapy vs placebo for 1 month on SDB and the AT and chemosensitivity during NREM sleep.
|
Elderly males with sleep apnea and adequate testosterone levels will ingest placebo vs finasteride, at 5 mg a day for 1 month (mo).
After 1 mo, while still on the drug, on the final 2 consecutive nights, the investigators will perform i) physiology tests and ii) in-lab follow-up PSG.
Blood tests will be performed to check sex hormone levels.
A washout period of 1 month prior to cross-over to the alternate arm (placebo).
|
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Apneic threshold- a measure of breathing instability
Time Frame: 2 days to 30 days
|
Measures of breathing instability including: Apneic threshold: this is the end-tidal Co2 at which a central apnea closes to a hypopnea is produced.
|
2 days to 30 days
|
Cerebrovascular responsiveness to carbon-dioxide
Time Frame: 7 days
|
Cerebrovascular response to different levels of CO2: this is a measure of the response of the cerebral blood flow to changes in carbon dioxide levels and is used as a measure of ventilatory control of breathing
|
7 days
|
Ventilatory responsiveness
Time Frame: 2 days to 30 days
|
Hypocapnic ventilatory response; this is calculated as the change in minute ventilation for corresponding changes in PETCO2.
|
2 days to 30 days
|
Carbon -dioxide reserve
Time Frame: 2 days to 30 days
|
This is a derived measure.
This is calculated as the difference between the apneic threshold PETCO2 (given above) and the control PETCO2.
|
2 days to 30 days
|
Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Apnea hypopnea index
Time Frame: 2 days to 30 days
|
Apnea hypopnea index- is a measure of severity of sleep apnea - this is calculated as the total number of apneas and hypopneas recorded during a sleep study divided by the total sleep time during the sleep study.
|
2 days to 30 days
|
Collaborators and Investigators
This is where you will find people and organizations involved with this study.
Investigators
- Principal Investigator: Susmita Chowdhuri, MD, John D. Dingell VA Medical Center, Detroit, MI
Publications and helpful links
The person responsible for entering information about the study voluntarily provides these publications. These may be about anything related to the study.
Study record dates
These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.
Study Major Dates
Study Start (Actual)
July 3, 2015
Primary Completion (Estimated)
June 30, 2024
Study Completion (Estimated)
June 30, 2024
Study Registration Dates
First Submitted
January 29, 2016
First Submitted That Met QC Criteria
March 3, 2016
First Posted (Estimated)
March 9, 2016
Study Record Updates
Last Update Posted (Actual)
August 18, 2023
Last Update Submitted That Met QC Criteria
August 16, 2023
Last Verified
August 1, 2023
More Information
Terms related to this study
Keywords
Additional Relevant MeSH Terms
- Nervous System Diseases
- Respiratory Tract Diseases
- Respiration Disorders
- Sleep Disorders, Intrinsic
- Dyssomnias
- Sleep Wake Disorders
- Signs and Symptoms, Respiratory
- Sleep Apnea Syndromes
- Apnea
- Physiological Effects of Drugs
- Molecular Mechanisms of Pharmacological Action
- Urological Agents
- Enzyme Inhibitors
- Hormones, Hormone Substitutes, and Hormone Antagonists
- Carbonic Anhydrase Inhibitors
- Natriuretic Agents
- Diuretics
- Anticonvulsants
- Hormone Antagonists
- Steroid Synthesis Inhibitors
- 5-alpha Reductase Inhibitors
- Acetazolamide
- Finasteride
Other Study ID Numbers
- PULM-008-14F
Plan for Individual participant data (IPD)
Plan to Share Individual Participant Data (IPD)?
NO
Drug and device information, study documents
Studies a U.S. FDA-regulated drug product
Yes
Studies a U.S. FDA-regulated device product
No
product manufactured in and exported from the U.S.
No
This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.
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