Laura Buratti*, Chiara Rocchi, Viviana Totaro and Mauro Silvestrini
Received: October 12, 2020; Published: October 21, 2020
Corresponding author: Laura Buratti, Neurological Clinic, Marche Polytechnic University, Via Conca 71, 60020 Ancona, Italy
Keywords: Obstructive sleep apnea; flow limitation; allergic rhinitis; trazodone; polygraphy
We report the case of a 44 years old woman referred to the
outpatient Sleep Disorder Service of the Neurological Clinic, Marche
Polytechnic University for a symptomatology characterized by
difficulty in maintaining sleep and a feeling of unrefreshing sleep on
waking. On clinical history, she referred an allergic rhinitis, treated
with short cycles of inalatory steroids and vasoconstrictors. At the
moment of our observation, she did not assume any treatment .
Due to the reported symptoms, particular attention was paid to the
possible presence of sleep disturbances, in particular sleep-related
breathing disorders. In this respect, patient reported a morning
dry mouth. Further, the partner referred an important snoring
and continuous lightening of sleep. Nocturnal apnea events were
not reported as well as discomfort or abnormal movements in
the legs. No other disturbance suggestive for NREM or REM sleep
disturbances, nor fewer specific phases were evidenced. Patient
was then submitted to a polygraphy which showed a rhonchopathy
associated with air flow limitations, a high arousal index and
elevated heart rate variability. The exam excluded periodic limb
movements (Figure 1) [2,3]. Considering the history of allergic
rhinitis and also to evaluate the possible presence of anomalies
of the upper airways, an ENT assessment was indicated. Further,
in relation to the difficulty in maintaining sleep and for the high
indices of autonomic dysfunction, a pharmacological treatment
with trazodone at the dose of sleep stabilizer, 30 mg in the evening
ENT evaluation showed a pattern of nasal congestion without other alteration of the upper airways. Specific topical therapy was prescribed, not taken by the patient for the improvement with trazodone. Infact after few days of treatment with trazodone the patient reported a significant improvement of symptomatology and after 30 days a poligraphic control showed a complete recovery of respiratory alterations and a normalization of autonomic dysfunction (Figure 2) . The particularly favorable and rapid evolution of patient’s symptomatology could be interpreted on the basis of the pharmacological properties of trazodone. It is possible to hypothesize that trazodone at low dosages, in addition to the anxiolytic and hypno-inducing effect, for its an antihistamine action was able to contemporary solve clinical pictures related to both insomnia and the respiratory dysfunction . Therefore, trazodone, in addition to stabilizing the sleep structure by increasing the arousal threshold, should deserve consideration in patients affected by allergic rhinitis with sleep disturbances. The advantage of having a valid therapeutic alternative would be very important in relation to the fact that steroids and vasoconstrictors, normally used in the treatment of allergic rhinitis, find an indication only in the short-term approach and have no effect on sleep disturbances.
Figure 1: Basal polygraphic picture: flow limitations, absence of periodic movements; arousal index (AI) 49.7;heart rate
variability (HRV) 4.1; Snoring 27.
HRV: LF/HF ratio,
LF (Low Frequency): Frequencies included between 0.04 and 0.15 Hz.
HF (High Frequency): Frequencies included between 0.15 and 0.4 Hz.
The LF band is considered mainly related to the activity of the sympathetic nervous system while the HF band is considered an expression of the parasympathetic activity.
The ratio between low and high frequencies (LF/HF) allows quantify the balance between the sympathetic and parasympathetic systems constituting the so-called
Figure 2: Polygraphic picture after one-month treatment with trazodone: resolution of the respiratory picture and normalization of the autonomic indices arousal index (AI) 11, heart rate variability (HRV) 1.3 Snoring 3%.
Bio chemistryUniversity of Texas Medical Branch, USA
Department of Criminal JusticeLiberty University, USA
Department of PsychiatryUniversity of Kentucky, USA
Department of MedicineGally International Biomedical Research & Consulting LLC, USA
Department of Urbanisation and AgriculturalMontreal university, USA
Oral & Maxillofacial PathologyNew York University, USA
Gastroenterology and HepatologyUniversity of Alabama, UK
Department of MedicineUniversities of Bradford, UK
OncologyCirculogene Theranostics, England
Radiation ChemistryNational University of Mexico, USA
Analytical ChemistryWentworth Institute of Technology, USA
Minimally Invasive SurgeryMercer University school of Medicine, USA
Pediatric DentistryUniversity of Athens , Greece
The annual scholar awards from Lupine Publishers honor a selected number Read More...
We know the financial complexity of Individual read more...
The annual scholar awards from Lupine Publishers honor a selected number read more...