title: Sertraline and rapid eye movement sleep without atonia: an 8-week, open-label study of depressed patients.
abstract: Previous studies have reported that selective serotonin reuptake inhibitors (SSRIs) may induce or exacerbate rapid eye movement (REM) sleep without atonia (RSWA) and increase the risk of developing REM sleep behavior disorder (RBD). However, most of these studies are retrospective and cross-sectional and employed small sample sizes and a mixture of SSRIs. In this 8-week open-label trial of sertraline in depressed patients (n = 31), depressed patients were administered 50mg sertraline at 8 am on the 1st day and subsequently titrated up to a maximum of 200mg/day. All patients underwent repeated video-polysomnography (vPSG) (baseline, 1st day, 14th day, 28th day, and 56th day). Both tonic (submental) and phasic (submental and anterior tibialis) RSWA events were visually counted. Tonic RSWA increased from 3.2 ± 1.8% at baseline to 5.1 ± 2.3% on the 1st day and 10.4 ± 2.7% on the 14th day; after that, measurements were stable until the 56th day. A similar profile was observed for phasic RSWA. The increases in tonic RSWA (r = 0.56, P = 0.004) and phasic RSWA (submental: r = -0.51, P = 0.02; anterior tibialis: r = 0.41, P = 0.04) were correlated with the degree of the prolonging of REM latency. All of RSWAs were not correlated with patients' demographic and clinical characteristics. Sertraline may induce or exacerbate RSWA. In contrast to idiopathic RBD, sertraline-related RSWA had the specific characteristics of being correlated with the degree of the prolonging of REM latency and no predominance of male sex and elder age, suggesting different pathophysiological mechanisms. The antidepressant-related RSWA should be a potential public health problem in the depressed patients.
authors.affiliation: Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangdong Mental Health Center, Guangzhou 510120, China. Electronic address: zhang73bin@hotmail.com.
authors.forename: Bin
authors.initials: B
authors.lastname: Zhang
authors.forename: Yanli
authors.initials: Y
authors.lastname: Hao
authors.forename: Fujun
authors.initials: F
authors.lastname: Jia
authors.forename: Yi
authors.initials: Y
authors.lastname: Tang
authors.forename: Xueli
authors.initials: X
authors.lastname: Li
authors.forename: Wuhan
authors.initials: W
authors.lastname: Liu
authors.forename: Isabelle
authors.initials: I
authors.lastname: Arnulf
mesh_terms: D000293:Adolescent; D000328:Adult; D000928:Antidepressive Agents / Q000627:therapeutic use*; D003430:Cross-Sectional Studies; D003863:Depression / Q000150:complications* / Q000188:drug therapy*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D017286:Polysomnography; D011569:Psychiatric Status Rating Scales; D020187:REM Sleep Behavior Disorder / Q000188:drug therapy* / Q000209:etiology*; D012189:Retrospective Studies; D020280:Sertraline / Q000627:therapeutic use*; D013997:Time Factors; D014741:Video Recording; D055815:Young Adult
chemical_list: D000928:Antidepressive Agents; D020280:Sertraline
keywords: 5-HT; AASM-2007; AHI; AI; ANOVA; American Academy of Sleep Medicine 2007 version; BMI; CT; DA; DSM-IV; Depressed patient; Diagnostic and Statistical Manual of Mental Disorders Fourth Edition; ECG; EMG; EOG; ESS; Epworth sleepiness scale; HRSD; Hamilton rating scale for depression; MSLT; OCD; OSA; PD; PLMI; PLMS; PSG; PSQI; Parkinson's disorder; Pittsburgh sleep quality index; REM; REM sleep behavior disorder (RBD); REM sleep without atonia; RLS; RSWA; Rapid eye movement (REM) sleep without atonia (RSWA); SCID-2; SE; SL; SSRI; Sertraline; TESS-S; TESS-T; TRT; TST; WASO; apnea–hypopnea index; arousal index; body mass index; computed tomography; dopaminergic; electrocardiograph; electromyogram; electrooculograph; multiple sleep latency test; obsessive-compulsive disorder; obstructive sleep apnea; one-way analysis of variance; periodic limb movement during sleep; periodic limb movement index; polysomnogram; rapid eye movement; restless legs syndrome; selective serotonin reuptake inhibitors; serotonin; sleep efficiency; sleep latency; the second version of the Structured Clinical Interview for DSM-IV Axis I Disorders; total recording time; total sleep time; treatment emergent symptom scale-severity; treatment emergent symptom scale-treatment; vPSG; video-polysomnography; wake after sleep onset