ACUTE EFFECTS OF TRANSDERMAL NICOTINE ON SLEEP ARCHITECTURE, SNORING,AND SLEEP-DISORDERED BREATHING IN NONSMOKERS

Previous research has suggested that nicotine may be therapeutically u seful in the treatment of sleep-disordered breathing. The development of transdermal nicotine delivery systems has allowed us to test the ov ernight effectiveness of nicotine. Twenty nonsmoking subjects (10 men, 10 women) were recruited on the basis of a history of habitual snorin g that was confirmed by overnight laboratory monitoring. Subjects were then randomized (double-blind crossover design) to receive either pla cebo or an active patch that delivers 11 mg of nicotine over a 24-h pe riod. Patches were applied at 6 P.M. and removed at 6 A.M. the followi ng morning, at which time venous blood was obtained for determination of serum nicotine concentrations. Polysomnography was performed using standard techniques to assess sleep architecture and sleep-disordered breathing. Snoring was monitored with a sound-level meter and quantita tively analyzed. to determine the snoring index (SI) (number of snores per hour of sleep) and mean and maximum snoring. intensities. The age of the subjects was 46.9 +/- 11.4 yr (mean +/- SD) and their mean bod y mass index (BMI) 33.3 +/- 4.6 kg/m(2). A mean nicotine level was non detectable with placebo and 7.8 +/- 2.3 ng/ml with wearing of an activ e patch. Nicotine decreased total sleep time (TST) by 33 min (p less t han or equal to 0.01), sleep efficiency from 89.7 to 83.5% (p less tha n or equal to 0.01), and percent rapid eye movement (REM) sleep from 1 8.8 to 15.1% (p less than or equal to 0.01), and prolonged initial sle ep latency (ISL) from 6.7 to 18.2 min (p less than or equal to 0.01). No significant changes in non-rapid eye movement (NREM) sleep stages 1 , 2, 3-4, or arousal index were detected. Although the SI was unchange d (602 +/- 177 versus 607 +/- 205/h), mean snoring intensity decreased by 1.1 dB, p less than or equal to 0.01, with nicotine. A 1.4-dB redu ction in maximum snoring intensity with nicotine was not significant. Although the decrease in disordered-breathing-event (DBE) frequency fr om 13.6 +/- 15.4 to 11.4 +/- 12.5/h with nicotine was not significant, a highly significant negative correlation (r = -0.71, p less than or equal to 0.001) was detected between nicotine level and DBE duration d uring the active-patch night. in addition, lowest SpO(2) was positivel y correlated (r = 0.52, p less than or equal to 0.05) with serum nicot ine level. Nausea and emesis were the predominant side effects and wer e experienced by 50 and 20% of the subjects, respectively. In conclusi on, transdermal nicotine significantly disrupted sleep architecture an d produced no clinically significant improvements in either snoring or sleep-disordered breathing in this group of 20 nonsmoking snorers wit h mild sleep-disordered breathing. Increasing levels of nicotine were associated with a shorter DBE duration and less severe reductions in l owest SpO(2).