Classifications

• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
  • A61K31/00—Medicinal preparations containing organic active ingredients
  • A61K31/13—Amines
  • A61K31/135—Amines having aromatic rings, e.g. ketamine, nortriptyline
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
  • A61K31/00—Medicinal preparations containing organic active ingredients
  • A61K31/33—Heterocyclic compounds
  • A61K31/395—Heterocyclic compounds having nitrogen as a ring hetero atom, e.g. guanethidine or rifamycins
  • A61K31/41—Heterocyclic compounds having nitrogen as a ring hetero atom, e.g. guanethidine or rifamycins having five-membered rings with two or more ring hetero atoms, at least one of which being nitrogen, e.g. tetrazole
  • A61K31/4164—1,3-Diazoles
  • A61K31/4178—1,3-Diazoles not condensed 1,3-diazoles and containing further heterocyclic rings, e.g. pilocarpine, nitrofurantoin
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
  • A61K45/00—Medicinal preparations containing active ingredients not provided for in groups A61K31/00 - A61K41/00
  • A61K45/06—Mixtures of active ingredients without chemical characterisation, e.g. antiphlogistics and cardiaca
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
  • A61P11/00—Drugs for disorders of the respiratory system
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
  • A61P25/00—Drugs for disorders of the nervous system

Definitions

• This invention generally relates to methods for the pharmacological treatment of breathing disorders and, more specifically, to the administration of agents or compositions having serotonin-related receptor activity for the alleviation of sleep apnea (central and obstructive) and other sleep-related breathing disorders.
• sleep apnea is defined as an intermittent cessation of airflow at the nose and mouth during sleep.
• apneas of at least 10 seconds in duration have been considered important, but in most individuals the apneas are 20-30 seconds in duration and may be as long as 2-3 minutes. While there is some uncertainty as to the minimum number of apneas that should be considered clinically important, by the time most individuals come to attention of the medical community they have at least 10 to 15 events per hour of sleep.
• apneas have been classified into three types: central, obstructive, and mixed.
• central sleep apnea the neural drive to all respiratory muscles is transiently abolished.
• obstructive sleep apneas airflow ceases despite continuing respiratory drive because of occlusion of the oropharyngeal airway.
• Mixed apneas which consist of a central apnea followed by an obstructive component, are a variant of obstructive sleep apnea. The most common type of apnea is obstructive sleep apnea.
• OSAS Obstructive sleep apnea syndrome
• Obstructive sleep apnea syndrome's definitive event is the occlusion of the upper airway, frequently at the level of the oropharynx.
• the resultant apnea generally leads to a progressive-type asphyxia until the individual is briefly aroused from the sleeping state, thereby restoring airway patency and thus restoring airflow.
• snoring which is actually a high-frequency vibration of the palatal and pharyngeal soft tissues that results from the decrease in the size of the upper airway lumen, usually aggravates the narrowing via the production of edema in the soft tissues.
• Central sleep apnea is less prevalent as a syndrome than OSAS, but can be identified in a wide spectrum of patients with medical, neurological, and/or neuromuscular disorders associated with diurnal alveolar hypoventilation or periodic breathing.
• the definitive event in central sleep apnea is transient abolition of central drive to the ventilatory muscles.
• the resulting apnea leads to a primary sequence of events similar to those of OSAS.
• Several underlying mechanisms can result in cessation of respiratory drive during sleep. First are defects in the metabolic respiratory control system and respiratory neuromuscular apparatus. Other central sleep apnea disorders arise from transient instabilities in an otherwise intact respiratory control system.
• acetazolamide a carbonic anhydrase inhibitor that produced variable improvement in individuals with primary central apneas but caused an increase in obstructive apneas
• medroxyprogesterone a progestin that has demonstrated no consistent benefit in OSAS
• theophylline a compound usually used for the treatment of asthma, which may benefit patients with central apnea but appears to be of no use in adult patients with obstructive apnea.
• adenosine which is a ubiquitous compound within the body and which levels are elevated in individuals with OSAS, has been shown to stimulate respiration and is somewhat effective in reducing apnea in an animal model of sleep apnea.
• OSAS Other possible pharmacological treatment options for OSAS include agents that stimulate the brain activity or are opioid antagonists. Specifically, since increased cerebral spinal fluid opioid activity has been identified in OSAS, it is a logical conclusion that central stimulants or opioid antagonists would be a helpful treatment of OSAS. In reality, doxapram, which stimulates the central nervous system and carotid body chemoreceptors, was found to decrease the length of apneas but did not alter the average arterial oxygen saturation in individuals with obstructive sleep apnea. The opioid antagonist naloxone, which is known to stimulate ventilation was only slightly helpful in individuals with obstructive sleep apnea.
• OSAS is strongly correlated with the occurrence of hypertension
• agents such as angiotensin-converting enzyme (ACE) inhibitors may be of benefit in treating OSAS individuals with hypertension but this does not appear to be a viable treatment for OSAS itself.
• ACE angiotensin-converting enzyme
• the invention is directed to providing pharmacological treatments for the prevention or amelioration of sleep-related breathing disorders.
• the present invention is directed to methods for the prevention or amelioration of sleep-related breathing disorders, the method comprising the administration of an effective dose of serotonin receptor antagonist to a patient in need of such therapy.
• the present invention is also directed to methods comprising the administration of a combination of serotonin receptor antagonists for the prevention or amelioration of sleep-related breathing disorders.
• the combination of serotonin receptor antagonists may be directed to a single serotonin receptor subtype or to more than one serotonin receptor subtype.
• the present invention is further directed to methods comprising the administration of a combination of serotonin receptor antagonists in conjunction with a combination of serotonin receptor agonists for the prevention or amelioration of sleep-related breathing disorders.
• the combination of serotonin receptor antagonists as well as the combination of receptor agonist may be directed to a single serotonin receptor subtype or to more than one serotonin receptor subtype.
• the present invention is also directed to methods comprising the administration of a combination of serotonin receptor antagonists in conjunction with a ⁇ 2 adrenergic receptor subtype antagonist for the prevention or amelioration of sleep-related breathing disorders.
• the combination of serotonin receptor antagonists may be directed to a single serotonin receptor subtype or to more than one serotonin receptor subtype.
• Routes of administration for the foregoing methods may be by any systemic means including oral, intraperitoneal, subcutaneous, intravenous, intramuscular, transdermal, or by other routes of administration.
• Osmotic mini-pumps and timed-released pellets or other depot forms of administration may also be used. The only limitation being that the route of administration results in the ultimate delivery of the pharmacological agent to the appropriate receptor.
• Sleep-related breathing disorders include, but are not limited to, obstructive sleep apnea syndrome, apnea of prematurity, congenital central hypoventilation syndrome, obesity hypoventilation syndrome, central sleep apnea syndrome, Cheyne-Stokes respiration, and snoring.
• a serotonin receptor antagonist can be used in its free base form or as a quaternary ammonium salt form.
• serotonin receptor antagonists The quaternization of these serotonin receptor antagonists occurs by conversion of tertiary nitrogen atom into a quaternary ammonium salt with reactive alkyl halides such as, for example, methyl iodide, ethyl iodide, or various benzyl halides.
• reactive alkyl halides such as, for example, methyl iodide, ethyl iodide, or various benzyl halides.
• Some quaternary forms of a serotonin antagonist, specifically, methylated zatosetron has been shown to lack the ability to cross the blood-brain barrier (Gidda et ai, J. Pharmacol. Exp. Ther. 273:695-701 (1995)), and thus only works on the peripheral nervous system.
• a serotonin receptor antagonist is defined by the chemical compound itself and one of its pharmaceutically acceptable salts.
• Exemplary serotonin receptor antagonists include, but are not limited to, the free base form or a quaternized form of zatosetron, tropisetron, dolasetron, hydrodolasetron, mescaline, oxetorone, homochlorcyclizine, perlapine, ondansetron (GR38032F), ketanserin, loxapine, olanzapine, chlorpromazine, haloperidol, r (+) ondansetron, cisapride, norcisapride, (+) cisapride, (-) cisapride, (+) norcisapride, (-) norcisapride, desmethylolanzapine, 2- hydroxymethylolanzapine, 1 -(2-fluorophenyl)-3-(4-hydroxyaminoethyl)-prop-2-en- 1 -one-O- (2-dimethylaminoethyl)-oxime,
• Exemplary serotonin receptor agonists include, but are not limited to 8-OH-DPAT, sumatriptan, L694247 (2-[5-[3-(4-methylsulphonylamino)benzyl-l,2,4-oxadiazol-5-yl]-lH- indol-3yl]ethanamine), buspirone, alnitidan, zalospirone, ipsapirone, gepirone, zolmitriptan, risatriptan, 311C90, ⁇ -Me-5-HT, BW723C86 (l-[5(2-thienylmethoxy)-lH-3-indolyl[propan- 2-amine hydrochloride), and MCPP (m-chlorophenylpiperazine).
• a serotonin receptor agonist is defined by the chemical compound itself and one of its pharmaceutically acceptable salts.
• Exemplary ⁇ 2 adrenergic receptor antagonist include, but are not limited to phenoxybenzamine, phentolamine, tolazoline, terazosine, doxazosin, trimazosin, yohimbine, indoramin, ARC239, and prazosin or one of its pharmaceutically acceptable salts.
• Exemplary selective serotonin reuptake inhibitors include, but are not limited to, fluoxetine, paroxetine, fluvoxamine, sertraline, citalopram, norfluoxetine, r(-) fluoxetine, s(+) fluoxetine, demethylsertraline, demethylcitalopram, venlafaxine, milnacipran, sibutramine, nefazodone, R-hydroxynefazodone, (-)venlafaxine, and (+) venlafaxine.
• a selective serotonin reuptake inhibitor is defined by the chemical compound itself and one of its pharmaceutically acceptable salts.
• Figure 1 illustrates the effect of serotonin antagonist GR38032F (ondansetron) on the rate of apneas per hour of non-rapid eye movement (NREM) sleep as compared to control.
• GR38032F ondansetron
• NREM non-rapid eye movement
• Figure 3 shows the effect of the serotonin antagonist GR38032F (ondansetron) on the rate of apneas per hour of rapid-eye-movement (REM) sleep as compared to control.
• GR38032F ondansetron
• REM rapid-eye-movement
• Figure 4 illustrates the effect of the serotonin antagonist GR38032F (ondansetron) on the percentage of total recording time spent in REM sleep as compared to control. Each data point represents the mean ⁇ the standard error for 9 rats.
• Figure 5 shows the effects of the serotonin antagonist GR38032F (ondansetron) on the rate of normalized minute ventilation during wakefulness, NREM and REM sleep as compared to control.
• GR38032F ondansetron
• Figure 6 shows the effects of serotonin (0.79 mg/kg), GR38032F (0.1 mg/kg)+serotonin (0.79 mg/kg), and GR38032F (0.1 mg/kg) on spontaneous apneas in NREM sleep.
• FIG. 7 illustrates the effects of serotonin (0.79 mg/kg), GR38032 (0.1 mg/kg) +serotonin (0.79 mg/kg), and GR38032F (0.1 mg/kg) on spontaneous apneas during REM sleep.
• Example 1 describes the preparation of the animals for treatment with either serotonin antagonists or agonists or both and subsequent physiological recording and testing.
• Example 2 describes the methods for the physiological recording of treatment and control animals and results obtained from administration of a serotonin antagonist.
• Example 3 describes results obtained from the administration of serotonin followed by the administration of a serotonin receptor antagonist.
• Example 4 describes agents or compositions that posses a specific serotonin-related pharmacological activity that is used to effectively suppress or prevent sleep-related breathing disorders.
• EEG electrodes consisting of four stainless steel machine screws, having leads attached thereto, were threaded into the skull to rest on the dura over the parietal cortex.
• a thin layer of Justi® resin cement (Saslow Dental, Mt. Prospect, IL) was applied to cover the screw heads (of screws implanted in the skull) and surrounding skull to further promote the adhesion of the implant.
• EMG electrodes consisting of two ball-shaped wires were inserted into the bilateral neck musculature. All leads ⁇ i.e., EEG and EMG leads) were soldered to a miniature connector (39F1401, Newark Electronics, Schaumburg, IL). Lastly, the entire assembly was fixed to the skull with dental cement.
• a retractor was used to expose the contents of the abdomen and the intestine was held back using saline moistened gauze sponges.
• the aorta was dissected from the surrounding fat and connective tissues using sterile cotton applicators.
• a 3-0 silk suture was placed beneath the aorta and traction was applied to the suture to restrict the blood flow.
• the implant (TAl 1-PXT) was held by forceps while the aorta was punctured just cranial to the bifurcation using a 21 -gauge needle bent at the beveled end.
• the tip of the catheter was inserted under the needle using the needle as a guide until the thin-walled BP sensor section was within the vessel.
• tissue adhesive (Vetbond®, 3M, Minneapolis, MN) was applied to the puncture site and covered with a small square of cellulose fiber (approximately 5 mm ) so as to seal the puncture after catheter insertion.
• the radio implant was attached to the abdominal wall by 3-0 silk suture, and the incision was closed in layers. After the second surgery, animals were again allowed a one week recovery period prior to administration of the serotonin receptor antagonist and subsequent physiological recording.
• Physiological parameters from each animal were recorded on 2 occasions in random order, with recordings for an individual animal separated for at least 3 days. Fifteen minutes prior to each recording each animal received a systemic injection (lml/kg intraperitoneal bolus injection) of either saline (control) or lmg/kg of ondansetron (GR38032F; l,2,3,9-tetrahydro-9-methyl-3-[(2-methylimidazol-l-yl)methyl]carbazole-4-one, hydrochloride, dihydrate; Glaxo Wellcome, Inc., Research Triangle Park, NC). Polygraphic recordings were made from hours 10:00-16:00.
• Respiration was recorded by placing each animal, unrestrained, inside a single chamber plethysmograph (PLYUNl R/U; Buxco Electronics, Sharon, CT; dimension 6 in. x 10 in. x 6 in.) ventilated with a bias flow of fresh room air at a rate of 2 L/min.
• a cable plugged onto the animal's connector and passed through a sealed port was used to carry the bioelectrical activity from the head implant.
• Respiration, blood pressure, EEG activity, and EMG activity were displayed on a video monitor and simultaneously digitized 100 times per second and stored on computer disk (Experimenter's Workbench; Datawave Technologies, Longmont, CO).
• the events detected represent central apneas because decreased ventilation associated with obstructed or occluded airways would generate an increased plethysmographic signal, rather than a pause.
• An apnea index (AI) defined as apneas per hour in a stage were separately determined for NREM and REM sleep. The effects of sleep stage (NREM vs. REM) and injection (control vs. GR30832F) were tested using ANOVA with repeated measures. Multiple comparisons were controlled using Fisher's protected least significant difference (PLSD). In addition, the timing and volume of each breath were scored by automatic analysis (Experimenters' Workbench; Datawave Technologies, Longmont, CO).
• RR mean respiratory rate
• MV minute ventilation
• results of the administration of the serotonin antagonist GR38032F on the rate of apneas per hour of NREM sleep during the 6 hours of polygraphic recording demonstrated no significant effect of treatment or time over 6 hours (two- way ANOVA). However, there was a significant suppression of apneas during the first 2 hours of recording as determined by paired t-tests (p ⁇ 0.01 for each). This respiratory effect was associated with a significant suppression of NREM sleep by the GR38032F during the first 2 hours as demonstrated in Fig. 2. The percentage of NREM sleep in 6 hour recordings was lower in GR38032F administered rats than in controls, but the decrease reached statistical significance only during the first 2 hours of the recordings (p ⁇ 0.00l).
• results indicate that GR38032F had no effect on any cardiovascular variable (MBP and HP during W, NREM, and REM sleep) measured (p>0 ⁇ for each variable; see Table 1).
• exemplary serotonin receptor antagonists in its free base form or as a quaternary ammonium salt include, but are not , limited to (a) ketanserin, cinanserin, LY-53,857, metergoline, LY-278,584, methiothepin, p- NPPL, NAN-190, piperazine, SB-206553, SDZ-205,557, S-tropanyl-indole-S-carboxylate, 3- tropanyl-indole-3-carboxylate methiodide, methysergide (Research Biochemicals, Inc., Natick, MA); (b) risperidone (Janssen Pharmaceutica, Titusville, NJ); (c) cyproheptadine, clozapine, mianserin, ritanserin (Sigma Chemical Co., St.
• ondansetron granisetron (SmithKline Beecham, King of Prussia, PA), zatosetron, tropisetron, dolasetron, and hydrodolasetron;
• loxapine olanzapine, chlorpromazine, haloperidol, r (+) ondansetron, cisapride, norcisapride, (+) cisapride, (-) cisapride, (+) norcisapride, (-) norcisapride, desmethylolanzapine, 2-hydroxymethylolanzapine, l-(2-fluorophenyl)-3-(4- hydroxyaminoethyl)-prop-2-en- 1 -one-O-(2-dimethylarninoethyl)-oxirne, (f) mescaline, oxetorone, homochlorcyclizine, and perlapine and other serotonin receptor antagonists and
• each animal was recorded on four occasions, with recordings for an individual animal separated by at least three days. Fifteen minutes prior to each recording, each animal received (via intraperitoneal injection), in random order, one of the following: (a) saline solution (control); (b) 0.79 mg/kg serotonin; (c) 0.1 mg/kg GR38032F plus 0.79 mg/kg serotonin; or (d) 0.1 mg/kg GR38032F.
• saline solution control
• 0.79 mg/kg serotonin 0.1 mg/kg GR38032F plus 0.79 mg/kg serotonin
• 0.1 mg/kg GR38032F was administered at time 09:30 followed by 0.79 mg/kg serotonin at time 09:45. Polygraphic recordings were made from 10:00-16:00.
• Respiration BP, EEG, and EMG data were determined and recorded via the experimental procedure as specifically set forth above in Example 2.
• sleep apneas defined as cessation of respiratory effort for at least 2.5 s, were scored for each recording session and were associated with the stage in which they occurred: NHEM or REM sleep.
• the duration requirement of 2.5 s represents at least two "missed" breaths, which is analogous to a 10-s apnea duration requirement in humans.
• Results of the administration of either serotonin alone (0.79 mg/kg), GR38032F (0.1 mg/kg)+serotonin (0.79 mg/kg), or GR38032F alone (0.1 mg/kg) on the ability to promote spontaneous apneas in NREM sleep during a 6 hour polygraphic recording is set forth in Figure 6. Specifically, during NREM sleep, the spontaneous apnea index was not affected by any drug treatment.
• the likely peripheral site of action for the observed apnea-promoting effects of serotonin administration is thought to be the nodose ganglia of the vagus nerve. More specifically, several studies have concluded that the apnea component of the Bezold-Jarisch reflex results from the action of serotonin at the nodose ganglia in cats [Jacobs et al, Circ. Res., 29:145-155 (1971), Sampson et al, Life Sd., 15:2157-2165 (1975), Sutton, Pfllugers Arch., 389:181-187 (1981)] and rats [Yoshioka et al, J. Pharmacol. Exp.
• the serotonin-induced Bezold-Jarisch reflex in anesthetized animals includes apnea and bradycardia. At the dose employed, serotonin did not elicit changes in either heart rate or mean BP over the 6 hour recording period. Beat-to-beat heart rate and BP variability, assessed as coefficients of variation, were also unaffected by serotonin at the dose tested. The observed dissociation of cardiovascular and respiratory responses to serotonin indicates that changes in apnea expression were not baroreceptor mediated.
• apnea frequency in rats increases from deep slow- wave sleep to light NREM sleep to REM sleep, as is the case in man.
• the high incidence of apnea expression during REM sleep may be related to respiratory changes that take place during this sleep state.
• breathing becomes shallow and irregular [Orem et al, Respir. Physiol, 30:265-289 (1977); Phillipson, Annu. Rev. Physiol, 40:133-156 (1978); Sieck et al, Exp.
• the role of serotonin activity in the peripheral nervous system in REM apnea genesis may arise from a serotonergic modulation of either tonic or phasic activity of respiratory afferent activity, especially in the vagus nerves. Therefore, the brainstem respiratory integrating areas may be rendered more vulnerable to fluctuating afferent inputs during REM sleep.
• serotonin plays an important and integral role in apnea genesis, which is both highly site and receptor subtype specific. More specifically, the efficacy of a serotonin receptor antagonist to suppress apnea is based on its activity in the peripheral nervous system, with the nodose ganglia of the vagus nerves appearing to be a crucial target site. 5-hydroxytryptamine 2 and 5-hydroxytryptamine 3 receptors at this site are clearly implicated in serotonin-induced apnea in anesthetized animals [Yoshioka et al, J. Pharmacol, Exp. Therp., 260:917-924 (1992)].
• sleep related breathing disorders may be effectively prevented or suppressed via systemic administration of pharmacological agents exhibiting either serotonin type 2 or type 3 receptor antagonism, alone or in combination as well as agents that exhibit both serotonin type 2 and type 3 receptor antagonism.
• Effective treatments for the prevention or suppression of sleep-related breathing disorders include systemic administration of a 5-hydroxytryptamine 2 or 5- hydroxytryptamine 3 receptor antagonist either alone or in combination.
• the serotonin receptor antagonist has activity only in the peripheral nervous system and/or does not cross the blood-brain barrier.
• the serotonin receptor antagonist displays both 5-hydroxytryptarnine 2 and 5-hydroxytryptamine 3 receptor subtype antagonism.
• buspirone acts systemically, 5-hydroxytryptaminei receptors in the peripheral nervous system have not been shown to play a role in apnea genesis.
• the modest apnea suppression induced by buspirone is a central nervous system effect that goes unopposed by serotonergic effects in the peripheral nervous system.
• sleep related breathing disorders may be effectively prevented or suppressed via systemic administration of
• agents that exhibit both the proper antagonistic and agonistic pharmacological profile ⁇ i.e., an agent that is both an agonist and antagonist at the receptor subtypes set forth above.
• Preferred embodiments include the following:
• serotonin receptor agonists such as, but not limited to 8-OH-DPAT (8-hydroxy-2-(di-7?-propylamino)tetralin, sumatriptan, L694247 (2-[5-[3-(4-methylsulphonylamino)benzyl-l,2,4-oxadiazol-5-yl]-lH-indol- 3yl]ethanamine), buspirone, alnitidan, zalospirone, ipsapirone, gepirone, zolmitriptan, risatriptan, 311C90, ⁇ -Me-5-HT, BW723C86 (l-[5(2-thienylmethoxy)-lH ⁇ 3-indoryl[propan- 2-amine hydrochloride), MCPP (m-chlorophenylpiperazine), as well as others may be used in conjunction with serotonin receptor antagonists to prevent
• Pharmacological mechanisms of action other than serotonin precursors or SSRIs may also be exploited to enhance central nervous system serotonin activity. Indeed, at least one mechanism allows augmented serotonin release to be selectively targeted at the central nervous system. Specifically, antagonism of presynaptic ⁇ 2 adrenergic receptors located on brainstem serotonergic neurons (heteroreceptors) enhances serotonin release.
• sleep related breathing disorders may also be effectively suppressed or prevented via systemic administration of pharmacological agents of combinations of agents having ⁇ 2 adrenergic antagonist activity with either serotonin type 2 or type 3 receptor antagonist activity (either alone or in combination with one another).
• Preferred embodiments include:
• ⁇ 2 adrenergic receptor antagonists such as, but not limited to phenoxybenzamine, phentolamine, tolazoline, terazosine, doxazosin, trimazosin, yohimbine, indoramin, ARC239, prazosin as well as others may be used in conjunction with serotonin receptor antagonists to prevent or ameliorate sleep-related breathing disorders.
• An individual diagnosed with a sleep-related breathing disorder is administered either a composition or agent having any of the foregoing pharmacological profiles in an amount effective to prevent or suppress such disorders.
• the specific dose may be calculated according to such factors as body weight or body surface. Further refinement of the calculations necessary to determine the appropriate dosage for treatment of sleep-related breathing disorders is routinely made by those of ordinary skill in the art without undue experimentation. Appropriate dosages may be ascertained through use of established assays for determining dosages.
• Routes of administration for the foregoing methods may be by any systemic means including oral, intraperitoneal, subcutaneous, intravenous, intramuscular, transdermal, or by other routes of administration. Osmotic mini-pumps and timed-released pellets or other depot forms of administration may also be used.
• sleep apnea is ameliorated by administering a combination of a serotonin receptor antagonist and an SSRJ. More preferably, the serotonin receptor antagonist is ondansetron. In another preferred embodiment, the SSRI is fluoxetine. More preferably, the serotonin receptor antagonist is ondansetron and the SSRI is fluoxetine. Preferably, the dosages of the serotonin receptor antagonist and the SSRI are each, independently, between about 0.5 and about 10 mg/kg/day, more preferably between about 1 mg/kg/day and about 5 mg/kg/day, even more preferably between about 1 mg/kg/day and about 2 mg/kg/day.
• This dosage corresponds to a human dosage of about 2 to about 100 mg/day.
• the ratio of serotonin receptor antagonist to SSRI is about 1:1.
• the combination is ondansetron and fluoxetine, in a ratio of about 1 :1, at a dosage of about 1 mg/kg/day of each.
• sleep apnea is ameliorated by administering to an individual in need thereof either (a) a unit dose composition containing a serotonin receptor antagonist and a unit dose composition containing a SSRI or (b) a unit dose composition containing a serotonin receptor antagonist and an SSRI.
• the unit dose(s) contains sufficient amounts of the serotonin receptor antagonist and SSRI such that a ratio of the plasma concentration of the serotonin receptor antagonist and the SSRI is about 1 :1.
• the serotonin receptor antagonist and SSRI are administered from different unit dose compositions, i.e., alternative (a), it is preferred that the two unit dose compositions are administered essentially simultaneously, or within a short time period of one another, e.g., one hour or less.
• a unit dose composition contains a serotonin receptor antagonist in an amount of about 2 mg to about 20 mg, and preferably about 5 to about 20 mg.
• a unit dose composition contains an SSRI in an amount of about 2 to about 20 mg, and preferably about 4 to about 20 mg.
• the unit dose composition can contain the serotonin receptor antagonist and SSRI, individually, in an amount of about 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, or 20 mg.
• Persons skilled in the art are capable of determining the amount of serotonin receptor antagonist and SSRI to include in a unit dose composition to arrive at a desired plasma ratio of serotonin receptor antagonist to SSRI, e.g., the preferred plasma ratio of about 1:1.
• the unit dose compositions preferably are administered one time per twenty-four hour period. However, in some individual cases a unit dose composition may have to be administered more or less frequently. Dosage amounts and frequency of administration are determined by the individual patient, the severity of the condition, and the attending physician.

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