U.S. patent application number 16/951048 was filed with the patent office on 2021-10-21 for oxytocin improves treatment of obstructive sleep apnea.
The applicant listed for this patent is THE GEORGE WASHINGTON UNIVERSITY. Invention is credited to Vivek JAIN, Heather JAMESON, Jay Shawn KIMBRO, David MENDELOWITZ.
Application Number | 20210322510 16/951048 |
Document ID | / |
Family ID | 1000005683428 |
Filed Date | 2021-10-21 |
United States Patent
Application |
20210322510 |
Kind Code |
A1 |
MENDELOWITZ; David ; et
al. |
October 21, 2021 |
OXYTOCIN IMPROVES TREATMENT OF OBSTRUCTIVE SLEEP APNEA
Abstract
The present disclosure provides methods for treating obstructive
sleep apnea (OSA) and OSA induced cardiorespiratory diseases. The
disclosure provides, inter alia, methods for treating or
alleviating: OSA or OSA induced hypertension, cardiac arrhythmias,
myocardial ischemia, sudden cardiac death or stroke, by
administering oxytocin. The disclosure further provides methods for
improving sleep satisfaction in OSA patients by administering
oxytocin.
Inventors: |
MENDELOWITZ; David; (Vienna,
VA) ; JAIN; Vivek; (McLean, VA) ; JAMESON;
Heather; (Lynnfield, MA) ; KIMBRO; Jay Shawn;
(Stevensville, MD) |
|
Applicant: |
Name |
City |
State |
Country |
Type |
THE GEORGE WASHINGTON UNIVERSITY |
Washington |
DC |
US |
|
|
Family ID: |
1000005683428 |
Appl. No.: |
16/951048 |
Filed: |
November 18, 2020 |
Related U.S. Patent Documents
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Application
Number |
Filing Date |
Patent Number |
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16184091 |
Nov 8, 2018 |
10842845 |
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16951048 |
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15327252 |
Jan 18, 2017 |
10166268 |
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PCT/US2015/038970 |
Jul 2, 2015 |
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16184091 |
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62028972 |
Jul 25, 2014 |
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Current U.S.
Class: |
1/1 |
Current CPC
Class: |
A61K 9/0043 20130101;
A61K 38/095 20190101 |
International
Class: |
A61K 38/095 20060101
A61K038/095; A61K 9/00 20060101 A61K009/00 |
Goverment Interests
STATEMENT REGARDING FEDERALLY SPONSORED RESEARCH OR DEVELOPMENT
[0002] This disclosure was made with Government support under
contract R01-HL72006 awarded by the NIH. The U.S. Government has
certain rights in the disclosure.
Claims
1-29. (canceled)
30. A method for treating a patient suffering from obstructive
sleep apnea induced bradycardia, comprising: intranasally
administering to the patient at least 40 International Units (IU)
of oxytocin within an hour of the patient falling asleep.
31. The method of claim 30, wherein the administration of oxytocin
reduces the incidence of bradycardia associated with obstructive
events.
32. The method of claim 30, wherein the administration of oxytocin
reduces the percent incidence of bradycardia associated with
obstructive events by at least 5%.
33. The method of claim 30, wherein the administration of oxytocin
increases the respiratory rate in the patient during
non-obstructive periods while sleeping.
34. The method of claim 30, wherein the administration of oxytocin
increases the respiratory rate in the patient during
non-obstructive periods within 2 hours of sleep onset.
35. The method of claim 30, wherein the administration of oxytocin
increases the respiratory rate in the patient during
non-obstructive periods while sleeping by at least 0.5
breaths/min.
36. The method of claim 30, wherein the patient is receiving
continuous positive airway pressure (CPAP) therapy.
37. The method of claim 30, wherein the administration of oxytocin
reduces the hypertension experienced by the patient.
38. The method of claim 30, wherein the administration of oxytocin
maintains the heart rate and/or blood pressure of the patient.
39. The method of claim 30, wherein the administration of oxytocin
improves sleep quality in the patient.
40. The method of claim 30, wherein the administration of oxytocin
decreases the number of arousals per hour experienced by the
patient during sleep.
41. The method of claim 30, wherein the administration of oxytocin
decreases the number of arousals per hour experienced by the
patient during sleep by at least 10%.
42. The method of claim 30, wherein the administration of oxytocin
decreases the oxygen desaturation experienced by the patient during
sleep.
43. The method of claim 30, wherein the administration of oxytocin
increases the minimum percent oxygen saturation experienced by the
patient during sleep by at least 1%.
44. The method of claim 30, wherein the administration of oxytocin
decreases the duration of apnea experienced by the patient during
sleep.
45. The method of claim 30, wherein the administration of oxytocin
decreases the duration of apnea experienced by the patient during
sleep by at least 5%.
46. The method of claim 30, wherein the administration of oxytocin
decreases the duration of apnea experienced by the patient during
sleep by at least 10%.
47. A method for increasing nocturnal respiration rate in a patient
in need thereof, comprising: intranasally administering to the
patient at least 40 International Units (IU) of oxytocin within an
hour of the patient falling asleep.
48. The method of claim 47, wherein the administration of oxytocin
increases the respiratory rate of the patient during
non-obstructive periods while sleeping.
49. The method of claim 47, wherein the administration of oxytocin
increases the respiratory rate of the patient during
non-obstructive periods within 2 hours of sleep onset.
50. The method of claim 47, wherein the administration of oxytocin
increases the respiratory rate in the patient during
non-obstructive periods while sleeping by at least 0.5
breaths/min.
51. The method of claim 47, wherein the administration of oxytocin
increases the respiratory rate in the patient during
non-obstructive periods while sleeping by at least 0.5 breaths/min
within 2 hours of sleep onset.
52. A kit for improving sleep quality in a patient suffering from
obstructive sleep apnea, comprising: a dose of at least 40
International Units (IU) of oxytocin; means for intranasal
administration of the oxytocin dose; and instructions for use of
the oxytocin dose less than one hour prior to sleep onset.
53. A kit for treating obstructive sleep apnea in a patient
receiving continuous positive airway pressure (CPAP) therapy,
comprising: a dose of at least 40 International Units (IU) of
oxytocin; and means for administration of the oxytocin dose via the
CPAP machine within an hour of sleep onset.
54. A therapeutic device for treating obstructive sleep apnea in a
patient receiving continuous positive airway pressure (CPAP)
therapy, comprising: a CPAP machine; a dose of at least 40
International Units (IU) of oxytocin; and means for administration
of the oxytocin dose via the CPAP machine within an hour of sleep
onset.
55. A composition comprising a dose of at least 40 International
Units (IU) of oxytocin, wherein the composition is contained in a
device for intranasal administration, and wherein the device
administers at least 40 IU of oxytocin at one time.
Description
CROSS REFERENCE TO RELATED APPLICATIONS
[0001] The present application is a continuation of U.S. patent
application Ser. No. 16/184,091, filed Nov. 8, 2018 (U.S. Pat. No.
10,842,845, issue date of Nov. 24, 2020), which is a continuation
of U.S. patent application Ser. No. 15/327,252, filed Jan. 18, 2017
(now U.S. Pat. No. 10,166,268, issued Jan. 1, 2019), which is a 371
national phase entry of PCT Application No. PCT/US2015/038970,
filed Jul. 2, 2015, which claims the benefit of priority to U.S.
Provisional Application No. 62/028,972, filed on Jul. 25, 2014, the
contents of each of which are hereby incorporated by reference in
their entirety.
FIELD OF THE DISCLOSURE
[0003] The present disclosure relates to methods and compositions
for treating obstructive sleep apnea (OSA) and OSA induced
cardiorespiratory diseases. More particularly, the disclosure
relates to compositions and methods that are useful for treating
OSA and OSA induced hypertension and cardiac dysfunction and to
compositions and methods that are useful for improving sleep
quality in OSA patients.
BACKGROUND
[0004] Patients with obstructive sleep apnea (OSA) experience
repetitive collapses of the upper airway during sleep causing
intermittent periods of hypoxia and hypercapnia (H/H) accompanied
by arterial oxygen desaturations and increases in arterial carbon
dioxide levels, ultimately altering both cardiac parasympathetic
and sympathetic nervous system activity (Bradley and Floras, 2009;
Leung, 2009; Loke et al., 2012). Upon termination of apneas,
asphyxia causes a brief arousal from sleep, sympathetic activity
increases and vagal tone decreases leading to surges in blood
pressure (BP) and heart rate (HR) (Bradley and Floras, 2009; Leung,
2009; Loke et al., 2012). These acute effects of OSA are thought to
cause chronic long term changes in cardiovascular dysfunction
including hypertension, arrhythmias, and cardiovascular mortality
(Bradley and Floras, 2009). Indeed, patients suffering from OSA
have increases in blood pressure, lower heart rate variability, and
reduced baroreflex sensitivity (Carlson et al., 1996; Trimer et
al., 2013; Konecny et al., 2014), with chronic impairment in
cardiac autonomic function i.e., sympathetic hyperactivity and
diminished parasympathetic activity (Trimer et al. 2013). While
identification of the mechanisms underlying the elevations in
sympathetic nerve activity in CIH and OSA has been the focus of
numerous studies (Fletcher et al., 1999; Fletcher et al., 2002; Kc
et al., 2010; Zoccal et al., 2011); studies identifying the
characteristics and mechanisms underlying depressed cardiac
parasympathetic activity are scarce.
[0005] Exposure to chronic intermittent hypoxia (CIH) or
hypoxia/hypercapnia (CIH/H) during the sleeping period of animals
mimics the repetitive episodes of H/H that occur in humans with OSA
and thus, serve as an animal model of OSA. Similar to what is
observed in patients with OSA, animals exposed to CIH or CIH/H
experience decreased baroreflex sensitivity, increased sympathetic
activity, diminished parasympathetic activity to the heart, and
develop hypertension within 3 weeks of CIH/H (Carlson et al, 1996;
Dyavanapalli et al., 2014; Lai et al., 1985; Parish and Somers,
2004; Pinol et al., 2014).
[0006] The parasympathetic activity to heart arises from cardiac
vagal neurons (CVNs) located in the nucleus ambiguus (NA) and
dorsal motor nucleus of the vagus (DMNX) that dominate the control
of heart rate (Mendelowitz 1999) (FIG. 1). The preganglionic vagal
efferent nerve terminals of the CVNs synapse with the
postganglionic intracardiac ganglia neurons located within the
connective and fat tissue surrounding sinoatrial and
atrioventricular nodes (Armour 2008). CVNs are typically
intrinsically silent and thus depend on synaptic inputs
(glutamatergic, GABAergic, and glycinergic) to dictate their
activity (Mendelowitz 1996; Willis et al. 1996; Neff et al. 1998;
Wang et al. 2001; Wang et al. 2003).
[0007] The paraventricular nucleus of the hypothalamus (PVN) is
critical in controlling autonomic function under normal conditions
and regulating cardiovascular activity in response to hypoxic
stress. The adverse alterations in BP, HR, and respiration that
occur with CIH have been postulated to involve pathways from the
PVN to sympathetic brainstem nuclei. Recently, it has been
hypothesized that different PVN neurons projecting to
parasympathetic nuclei, particularly the dorsal vagal complex (DVC)
where parasympathetic cardiac control originates, differentially
alter autonomic balance (Kc and Dick, 2010). However, much less is
known concerning the function and role of the neurotransmission
from the PVN to parasympathetic areas of the brainstem in normal
and disease states. Consequently, there is a great need in the
medical community for understanding the mechanisms underlying the
parasympathetic control of cardiac dysfunction and for the
development of novel therapeutic compounds, compositions, and
methods of treatment, which help alleviate the aforementioned
cardiorespiratory side effects associated with OSA.
[0008] The present disclosure investigates the mechanisms
responsible for diminished parasympathetic control of cardiac
functions during OSA and shows that oxytocin-secreting PVN neurons,
as well as administration of oxytocin, are novel and powerful
targets to mitigate important negative characteristics of the apnea
as well as the adverse cardiorespiratory consequences of OSA.
SUMMARY OF THE DISCLOSURE
[0009] The present disclosure provides methods of treatment and
compositions for treating or alleviating obstructive sleep apnea
(OSA) and OSA induced cardiorespiratory diseases and compromised
sleep quality.
[0010] In aspects, the present disclosure provides methods for
treating or alleviating OSA, and OSA induced compromised sleep
quality and cardiorespiratory diseases such as hypertension,
cardiac arrhythmias, myocardial ischemia, sudden cardiac death, and
stroke, said methods comprising, inter alia, administering an
effective dose of oxytocin.
[0011] In aspects, the disclosure provides that many of the events
associated with OSA such as duration of apnea, arousals per hour,
increased blood pressure, increased heart rate, oxygen desaturation
and compromised sleep quality can be reduced or inhibited by
administration of oxytocin.
[0012] In some aspects, the present disclosure provides for an
improved method of OSA treatment, which comprises administering an
effective dose of oxytocin in conjunction with continuous positive
airway pressure (CPAP) therapy. In one embodiment, the effective
dose of oxytocin may be administered to OSA patients receiving CPAP
therapy via the CPAP inhalation system.
[0013] In one embodiment, the disclosure provides a method for
treating a patient suffering from obstructive sleep apnea,
comprising: administering to the patient an effective dose of
oxytocin.
[0014] In one embodiment, the disclosure provides a method for
treating a patient suffering from OSA induced cardiorespiratory
disease, comprising: administering to the patient an effective dose
of oxytocin. Cardiorespiratory diseases that may be treated or
alleviated from the methods of the present disclosure are selected
from the group consisting of: hypertension, cardiac arrhythmias,
myocardial ischemia, sudden cardiac death, and stroke. In another
embodiment, the disclosure provides a method for treating a patient
suffering from OSA induced hypertension, comprising: administering
to the patient an effective dose of oxytocin.
[0015] In some embodiments, the disclosure provides a method for
improving sleep quality in a patient suffering from obstructive
sleep apnea, comprising: administering to the patient an effective
dose of oxytocin.
[0016] In one embodiment, the patient suffering from obstructive
sleep apnea is receiving CPAP therapy.
[0017] In one embodiment, the effective dose of oxytocin is
administered intranasally. In one aspect, the effective dose of
oxytocin is about 20 International Units (IU) per day. In another
aspect, the effective dose of oxytocin is about 30 IU per day. In
yet another aspect, the effective dose of oxytocin is about 40 IU
per day. In still another aspect, the effective dose of oxytocin is
at least 40 IU per day.
[0018] In one embodiment, oxytocin is administered closer to the
sleeping time of the patient. In another embodiment, oxytocin is
administered about 10 minutes, 20 minutes, 30 minutes, 40 minutes,
50 minutes, or about 1 hour prior to sleeping. In yet another
embodiment, oxytocin is administered within an hour of the patient
falling asleep.
[0019] In one aspect, the administration of oxytocin prevents or
reduces the risk of developing OSA induced cardiorespiratory
diseases in the patient. In another aspect, the administration of
oxytocin reduces the hypertension experienced by the patient. In
yet another aspect, the administration of oxytocin maintains or
decreases the heart rate and/or blood pressure of the patient.
[0020] In one aspect, the administration of oxytocin improves sleep
quality or sleep satisfaction in the patient. In another aspect,
the administration of oxytocin decreases the number of arousals per
hour experienced by the patient during sleep. In one aspect, the
administration of oxytocin decreases the number of arousals per
hour experienced by the patient by at least 10%. In still another
aspect, the administration of oxytocin leads to a decrease in the
duration of apnea experienced by the patient during sleep. In one
aspect, the administration of oxytocin decreases the duration of
apnea experienced by the patient by at least 10%. In still another
aspect, the administration of oxytocin leads to a decrease in the
oxygen desaturation experienced by the patient during sleep.
[0021] In some embodiments, the disclosure provides a method for
treating a patient suffering from obstructive sleep apnea induced
hypertension, comprising: intranasally administering to the patient
at least 40 International Units (IU) of oxytocin within an hour of
the patient falling asleep.
[0022] In one embodiment, the disclosure provides a method for
improving sleep quality in a patient suffering from obstructive
sleep apnea, comprising: intranasally administering to the patient
at least 40 International Units (IU) of oxytocin within an hour of
the patient falling asleep, wherein the administration of oxytocin
decreases the number of arousals per hour experienced by the
subject during sleep. In one aspect, the administration of oxytocin
leads to improvement in empirical factors indicative of sleep
quality in the patient.
[0023] In other embodiments, the disclosure provides a method for
treating a patient suffering from obstructive sleep apnea induced
hypertension and compromised sleep quality, comprising:
intranasally administering to the patient at least 40 International
Units (IU) of oxytocin within an hour of the patient falling
asleep.
[0024] In still other embodiments, the disclosure provides a method
for treating obstructive sleep apnea in a patient receiving
continuous positive airway pressure (CPAP) therapy, comprising:
administering to the patient at least 40 International Units (IU)
of oxytocin intranasally via the CPAP inhalation system within an
hour of the patient falling asleep.
[0025] In one aspect, the disclosure provides a method for treating
obstructive sleep apnea in a patient receiving continuous positive
airway pressure (CPAP) therapy, comprising: intranasally
administering to the patient about 5 International Units (IU) of
oxytocin per hour via the CPAP inhalation system for about 8 hours.
In another aspect, oxytocin is administered to the patient
intranasally via the CPAP inhalation system at the rate of about
5.7 IU/hour for about 7 hours. In yet another aspect, oxytocin is
administered to the patient intranasally via the CPAP inhalation
system at the rate of about 6.6 IU/hour for about 6 hours. In yet
another aspect, oxytocin is administered to the patient
intranasally via the CPAP inhalation system at the rate of about 8
IU/hour over the sleep period of 5 hours.
[0026] In certain embodiments, the disclosure provides a method for
treating a patient suffering from obstructive sleep apnea induced
cardiorespiratory disease, comprising: intranasally administering
to the patient at least 40 International Units (IU) of oxytocin
within an hour of the patient falling asleep.
[0027] In some embodiments, the disclosure provides a method for
treating a patient suffering from obstructive sleep apnea,
comprising: activating oxytocin-secreting neurons in the
paraventricular nucleus (PVN) of the hypothalamus.
BRIEF DESCRIPTION OF THE DRAWINGS
[0028] FIG. 1 shows the schematic for parasympathetic control of
cardiac function.
[0029] FIG. 2A shows changes in systolic and diastolic blood
pressure from day 1 (control) to day 28 of CIH/H exposure. Systolic
(solid line) and diastolic (dash line) blood pressures
significantly increased from day 6 and day 16, respectively,
compared to day 1 control and reached to hypertensive levels by day
21. n=6; *p<0.05; One way ANOVA. The values represent an average
blood pressure value recorded for 20 minutes during exposure to air
in days prior to and during CIH/H exposures. FIG. 2B shows changes
in heart rate in response to normoxia and an acute bout of H/H (3
mins) at the onset and after 4 weeks of CIH/H exposure. n=6;
*p<0.05; Student's paired t-test. FIG. 2C shows changes in mean
arterial blood pressure (MAP) in response to normoxia and an acute
bout of H/H (3 mins) at the onset and after 4 weeks of CIH/H
exposure. n=6; **p<0.05; Student's paired t-test.
[0030] FIG. 3A shows representative traces in control conditions
showing GABAergic spontaneous IPSCs recorded from CVNs in the NA of
unexposed animals while applying glycinergic and glutamatergic
blockers. FIG. 3B shows representative traces in control conditions
showing GABAergic spontaneous IPSCs recorded from CVNs in the NA of
CIH/H exposed animals while applying glycinergic and glutamatergic
blockers. FIG. 3C shows the quantitative histograms depicting the
frequency of GABAergic IPSCs in CVNs in the NA of unexposed and
CIH/H exposed animals. FIG. 3D shows representative traces in
control conditions showing GABAergic spontaneous IPSCs recorded
from CVNs in the DMNX of unexposed animals while applying
glycinergic and glutamatergic blockers. FIG. 3E shows
representative traces in control conditions showing GABAergic
spontaneous IPSCs recorded from CVNs in the DMNX of CIH/H exposed
animals while applying glycinergic and glutamatergic blockers. FIG.
3F shows the quantitative histograms depicting the frequency of
GABAergic IPSCs in CVNs in the DMNX of unexposed and CIH/H exposed
animals. The numbers in parentheses represent `n` value.
*p<0.05, unpaired t-test.
[0031] FIG. 4A shows representative traces in control conditions
showing glycinergic IPSCs recorded from CVNs in the NA of unexposed
animals while applying GABAergic and glutamatergic blockers. FIG.
4B shows representative traces in control conditions showing
glycinergic IPSCs recorded from CVNs in the NA of CIH/H exposed
animals while applying GABAergic and glutamatergic blockers. FIG.
4C shows the quantitative histograms depicting the frequency of
glycinergic IPSCs in CVNs in the NA of unexposed and CIH/H exposed
animals. FIG. 4D shows representative traces in control conditions
showing glycinergic IPSCs recorded from CVNs in the DMNX of
unexposed animals while applying GABAergic and glutamatergic
blockers. FIG. 4E shows representative traces in control conditions
showing glycinergic IPSCs recorded from CVNs in the DMNX of CIH/H
exposed animals while applying GABAergic and glutamatergic
blockers. FIG. 4F shows the quantitative histograms depicting the
frequency of glycinergic IPSCs in CVNs in the DMNX of unexposed and
CIH/H exposed animals. The numbers in parentheses represent `n`
value. *p<0.05, unpaired t-test.
[0032] FIG. 5A shows representative traces in control conditions
showing glutamatergic EPSCs recorded from CVNs in the NA of
unexposed animals while applying GABAergic and glycinergic
blockers. FIG. 5B shows representative traces in control conditions
showing glutamatergic EPSCs recorded from CVNs in the NA of CIH/H
exposed animals while applying GABAergic and glycinergic blockers.
FIG. 5C shows the bar graph depicting the frequency of
glutamatergic EPSCs in CVNs in the NA of unexposed and CIH/H
exposed animals. FIG. 5D shows the bar graph depicting the
amplitude of glutamatergic EPSCs in CVNs in the NA of unexposed and
CIH/H exposed animals. FIG. 5E shows representative traces in
control conditions showing glutamatergic EPSCs recorded from CVNs
in the DMNX of unexposed animals while applying GABAergic and
glycinergic blockers. FIG. 5F shows representative traces in
control conditions showing glutamatergic EPSCs recorded from CVNs
in the DMNX of CIH/H exposed animals while applying GABAergic and
glycinergic blockers. FIG. 5G shows the bar graph depicting the
frequency of glutamatergic EPSCs in CVNs in the DMNX of unexposed
and CIH/H exposed animals. FIG. 5H shows the bar graph depicting
the amplitude of glutamatergic EPSCs in CVNs in the DMNX of
unexposed and CIH/H exposed animals. The numbers in parentheses
represent `n` value. *p<0.05, unpaired t-test.
[0033] FIG. 6A shows representative traces of GABAergic IPSCs
recorded from CVNs in the NA of unexposed animals in control
conditions and following H/H exposure for 10 minutes. FIG. 6B shows
the histograms depicting the frequency of GABAergic IPSCs recorded
from CVNs in the NA of unexposed animals in control conditions and
H/H (10 minutes) conditions. FIG. 6C shows the histograms depicting
the amplitude of GABAergic IPSCs recorded from CVNs in the NA of
unexposed animals in control conditions and H/H (10 minutes)
conditions. FIG. 6D shows representative traces of GABAergic IPSCs
recorded from CVNs in the DMNX of unexposed animals in control
conditions and following H/H exposure for 10 minutes. FIG. 6E shows
the histograms depicting the frequency of GABAergic IPSCs recorded
from CVNs in the DMNX of unexposed animals in control conditions
and H/H (10 minutes) conditions. FIG. 6F shows the histograms
depicting the amplitude of GABAergic IPSCs recorded from CVNs in
the DMNX of unexposed animals in control conditions and H/H (10
minutes) conditions. FIG. 6G shows representative traces of
GABAergic IPSCs recorded from CVNs in the NA of CIH/H exposed
animals in control conditions and following H/H exposure for 10
minutes. FIG. 6H shows the histograms depicting the frequency of
GABAergic IPSCs recorded from CVNs in the NA of CIH/H exposed
animals in control conditions and H/H (10 minutes) conditions. FIG.
6I shows the histograms depicting the amplitude of GABAergic IPSCs
recorded from CVNs in the NA of CIH/H exposed animals in control
conditions and H/H (10 minutes) conditions. FIG. 6J shows
representative traces of GABAergic IPSCs recorded from CVNs in the
DMNX of CIH/H exposed animals in control conditions and following
H/H exposure for 10 minutes. FIG. 6K shows the histograms depicting
the frequency of GABAergic IPSCs recorded from CVNs in the DMNX of
CIH/H exposed animals in control conditions and H/H (10 minutes)
conditions. FIG. 6L shows the histograms depicting the amplitude of
GABAergic IPSCs recorded from CVNs in the DMNX of CIH/H exposed
animals in control conditions and H/H (10 minutes) conditions.
[0034] FIG. 7A shows representative traces of glycinergic IPSCs
recorded from CVNs in the NA of unexposed animals in control
conditions and following H/H exposure for 10 minutes. FIG. 7B shows
the histograms depicting the frequency of glycinergic IPSCs
recorded from CVNs in the NA of unexposed animals in control
conditions and H/H (10 minutes) conditions. FIG. 7C shows the
histograms depicting the amplitude of glycinergic IPSCs recorded
from CVNs in the NA of unexposed animals in control conditions and
H/H (10 minutes) conditions. FIG. 7D shows representative traces of
glycinergic IPSCs recorded from CVNs in the DMNX of unexposed
animals in control conditions and following H/H exposure for 10
minutes. FIG. 7E shows the histograms depicting the frequency of
glycinergic IPSCs recorded from CVNs in the DMNX of unexposed
animals in control conditions and H/H (10 minutes) conditions. FIG.
7F shows the histograms depicting the amplitude of glycinergic
IPSCs recorded from CVNs in the DMNX of unexposed animals in
control conditions and H/H (10 minutes) conditions. FIG. 7G shows
representative traces of glycinergic IPSCs recorded from CVNs in
the NA of CIH/H exposed animals in control conditions and following
H/H exposure for 10 minutes. FIG. 7H shows the histograms depicting
the frequency of glycinergic IPSCs recorded from CVNs in the NA of
CIH/H exposed animals in control conditions and H/H (10 minutes)
conditions. FIG. 7I shows the histograms depicting the amplitude of
glycinergic IPSCs recorded from CVNs in the NA of CIH/H exposed
animals in control conditions and H/H (10 minutes) conditions. FIG.
7J shows representative traces of glycinergic IPSCs recorded from
CVNs in the DMNX of CIH/H exposed animals in control conditions and
following H/H exposure for 10 minutes. FIG. 7K shows the histograms
depicting the frequency of glycinergic IPSCs recorded from CVNs in
the DMNX of CIH/H exposed animals in control conditions and H/H (10
minutes) conditions. FIG. 7L shows the histograms depicting the
amplitude of glycinergic IPSCs recorded from CVNs in the DMNX of
CIH/H exposed animals in control conditions and H/H (10 minutes)
conditions.
[0035] FIG. 8A shows representative action potential firing
recorded in current-clamp configuration from a PVN OXT neuron
expressing DREADDs before CNO and post CNO indicating excitatory
DREADDs activation with CNO application significantly increases the
firing of PVN OXT neurons. FIG. 8B shows quantitative bar charts
depict the frequency of action potentials before and after CNO
application in 7 PVN OXT neurons expressing DREADDs. *p<0.0001;
one-way ANOVA.
[0036] FIG. 9A shows representative responses from CHO cells due to
the release of oxytocin, as measured by activating oxytocin
receptors and subsequent increase in intracellular calcium levels,
deposited onto brainstem tissue taken from animals chronically
exposed to air, CIH/H, and CIH/H with daily PVN OXT neuron
activation. FIG. 9B shows quantitative bar charts depicting the
percent control fluorescence of CHO cell responses, as measured by
an increase in intracellular calcium levels, in brainstem tissue
taken from animals exposed to air (n=14), CIH/H (n=16), and CIH/H
with daily OXT neuron activation n=17). *p<0.05; one-way ANOVA
with repeated measure. .sup.+p<0.05; one-way ANOVA.
[0037] FIG. 10A shows changes in resting MAP before and after CNO
injection to activate PVN oxytocin neurons. MAP in oxytocin neuron
activated animals was significantly decreased 45 min after CNO
injection (n=8; .sup.+p<0.0001, one-way ANOVA). In sham animals,
CNO injection did not significantly change MAP (n=7; one-way
ANOVA). FIG. 10B shows changes in the heart rate (HR) in response
to CNO injection. 45 min after CNO injection, HR in
DREADDs-expressing was significantly decreased (n=8;
.sup.+p<0.0001, one-way ANOVA), while CNO injection did not
significantly change HR in sham animals (n=7; one-way ANOVA). The
values for both MAP (FIG. 10A) and HR (FIG. 10B) represent the
averages of each recorded 20 min prior to CNO injection and 45 min
after CNO injection on control days.
[0038] FIG. 11 shows that the activation of oxytocin neurons blunts
the increase in blood pressure that occurs with
hypoxia/hypercapnia.
[0039] FIG. 12 shows changes in MAP from control days to day 21 of
CIH/H exposure. MAP in sham animals significantly increased from
day 9 to day 21 compared to control day and reached hypertensive
levels by day 12 (n=7; .sup.+p<0.0001, one-way ANOVA). MAP did
not significantly increase in DREADDs-expressing OXT neuron
activated animals over the 21 days of CIH/H exposure compared to
control days (n=8; one-way ANOVA). MAP significantly increased in
sham animals compared to DREADDs-expressing animals from day 12 to
day 21 (*p<0.0001, two-way ANOVA with repeated measures).
[0040] FIG. 13 shows that the nasal administration of oxytocin to
OSA patients reduces the duration of apnea experienced by the
patients.
[0041] FIG. 14 shows adverse oxygen desaturations, in percent
oxygen, that occur with and without the administration of oxytocin
to OSA patients.
[0042] FIG. 15 shows that the nasal administration of oxytocin to
OSA patients reduces the number of arousals per hour experienced by
the patients.
[0043] FIG. 16 shows the nasal administration of oxytocin to OSA
patients improves their sleep quality or sleep satisfaction.
DETAILED DESCRIPTION
[0044] Sleep apnea is a common disorder in which an individual have
one or more pauses in breathing or shallow breaths while sleeping.
The most common type of sleep apnea is obstructive sleep apnea
(OSA). In this condition, the upper airway repetitively collapses
or becomes blocked during sleep. This causes shallow breathing or
breathing pauses. Breathing pauses or the duration of apnea can
last from a few seconds to minutes. They may occur 30 times or more
an hour. Typically, normal breathing then starts again, sometimes
with a loud snort or choking sound.
[0045] Breathing pauses in individuals with OSA lead to repetitive
intermittent periods of hypoxia/hypercapnia (H/H) during sleep that
are accompanied by arterial oxygen desaturations and increases in
arterial carbon dioxide levels. OSA is an independent risk factor
for the development of hypertension, coronary artery disease,
sudden cardiac death and arrhythmias (Sanchez-de-la-Torre et al.
2013). Patients suffering from OSA have increases in blood
pressure, lower heart rate variability, and reduced baroreflex
sensitivity (Carlson et al. 1996; Trimer et al. 2013; Konecny et
al. 2014), with chronic impairment in cardiac autonomic function
i.e., sympathetic hyperactivity and diminished parasympathetic
activity (Trimer et al. 2013).
[0046] Continuous positive airway pressure (CPAP) therapy is the
most common treatment for OSA, however this treatment is only
modestly effective (Bazzano et al., 2007), not well tolerated by
many patients, and its use is often discontinued. Thus, other
avenues of treatment are crucial to mitigate the adverse
cardiovascular consequences of OSA.
[0047] Animal models of OSA based on exposure to chronic
intermittent hypoxia (CIH) or hypoxia/hypercapnia (CIH/H) closely
mimic OSA in humans (Fletcher et al. 1992; Campen et al. 2005;
Kline et al. 2007). While it is known CIH decreases the baroreflex
control of heart rate and diminishes parasympathetic activity to
the heart, the exact mechanism of how CIH impairs the function of
cardiac vagal neurons (CVNs) is not known. The present disclosure
elucidates the mechanism of how hypoxia/hypercapnia experienced
during OSA leads to cardiac dysfunction and provides methods for
treating OSA and OSA-induced cardiac dysfunction by administering
an effective dose of oxytocin. The present disclosure is also
based, in part, on the surprising discovery that administration of
oxytocin to OSA patients also improves sleep quality experienced by
these patients.
Methods of Treating/Alleviating Obstructive Sleep Apnea
[0048] The present disclosure shows for the first time that
administration of oxytocin to OSA patients reduces the duration of
apnea experienced by the OSA patients. Accordingly, the present
disclosure provides methods for treating OSA in a patient
comprising administering to the patient an effective dose of
oxytocin.
[0049] In one embodiment, oxytocin is administered intranasally;
however, other routes of administration such as intravenous,
intramuscular, subcutaneous, oral, etc. may also be used. In one
embodiment, the effective dose of oxytocin is about 40
International Units (IU) per day. In one aspect, the effective dose
of oxytocin is administered closer to the sleeping time of the
patient, for instance, about 10 minutes, 20 minutes, 30 minutes, 40
minutes, 50 minutes, or about 60 minutes prior to the patient going
to sleep. In another aspect, oxytocin is administered within an
hour of the patient falling asleep.
[0050] In some embodiments, the OSA patient treated with oxytocin
may also be receiving continuous positive airway pressure (CPAP)
therapy. CPAP therapy includes wearing an inhalation system that
comprises a nasal mask/piece connected via hose to a small machine
that supplies air pressure to keep the airways open and prevent
airway occlusion.
[0051] In certain embodiments, the effective dose of oxytocin is
administered to the OSA patient receiving CPAP therapy via the CPAP
inhalation system. For instance, in one embodiment, the disclosure
provides methods for treating OSA in a patient receiving CPAP
therapy, comprising administering to the patient at least 40 IU of
oxytocin intranasally via the CPAP inhalation system within an hour
of the patient falling asleep. In another embodiment, the
disclosure provides methods for treating OSA in a patient receiving
CPAP therapy, comprising administering to the patient an effective
dose of oxytocin intranasally via the CPAP inhalation system over
the duration of the sleep. For example, in one embodiment, the
effective dose of oxytocin is 40 IU and it is administered via the
CPAP inhalation system at the rate of about 5 IU/hour over the
sleep period of 8 hours. In another embodiment, the effective dose
of oxytocin is 40 IU and it is administered via the CPAP inhalation
system at the rate of about 5.7 IU/hour over the sleep period of 7
hours. In yet another embodiment, the effective dose of oxytocin is
40 IU and it is administered via the CPAP inhalation system at the
rate of about 6.6 IU/hour over the sleep period of 6 hours. In yet
another embodiment, the effective dose of oxytocin is 40 IU and it
is administered via the CPAP inhalation system at the rate of about
8 IU/hour over the sleep period of 5 hours.
[0052] In OSA patients, the duration of apnea can vary and may last
from a few seconds to minutes. In one embodiment, administration of
oxytocin to OSA patients reduces the duration of apnea by at least
10%, 15%, 20%, 25%, 30%, 35%, 40%, 45%, 50%, 55%, 60%, 65%, or 70%
compared to the duration prior to the oxytocin treatment.
[0053] In one embodiment, administration of oxytocin to the OSA
patient reduces or prevents the risk of developing
cardiorespiratory diseases in the patient. The cardiorespiratory
diseases that may be prevented or alleviated by administration of
oxytocin include, but are not limited to hypertension, cardiac
arrhythmias, myocardial ischemia, sudden cardiac death and stroke.
The present disclosure also shows for the first time that
administration of oxytocin to OSA patients improves sleep
satisfaction and sleep quality in these patients.
[0054] CPAP is the most common treatment for OSA; however, many
patients do not comply with CPAP therapy due to problems such as
discomfort associated with wearing the nasal mask, difficulty
tolerating forced air, dry mouth or nose, etc. In one embodiment,
administration of oxytocin in accordance with the present
disclosure increases patient compliance with CPAP treatment as
oxytocin reduces the duration of sleep apnea and improves sleep
quality.
[0055] In certain embodiments, the present disclosure provides
methods for treating OSA patients that are dissatisfied with their
current OSA treatment comprising administering to the patients an
effective dose of oxytocin. Administration of oxytocin in
accordance with the present disclosure would increase patient
compliance with their current OSA treatment. In one embodiment,
patients dissatisfied with their current OSA treatment include
patients receiving CPAP therapy.
Oxytocin
[0056] Oxytocin is a nine amino acid cyclic peptide hormone with
two cysteine residues that form a disulfide bridge between
positions 1 and 6. Oxytocin is released from the posterior lobe of
the pituitary gland and stimulates the contraction of smooth muscle
of the uterus during labor and facilitates release of milk from the
breast during nursing. Studies have shown that oxytocin, likely
released from a different population of PVN neurons, may exert a
wide spectrum of other biological effects including control of
memory and learning processes, and various types of maternal and
sexual behavior. In addition, oxytocin may participate in the
control of cardiovascular functions, thermoregulation and fluid
balance. Oxytocin is approved by the Food and Drug Administration
for intravenous use to induce labor in pregnant women as well as
for the treatment of postpartum hemorrhage. At this time, there are
no clinical or regulatory guidelines for the use of oxytocin in the
treatment of sleep apnea.
[0057] The oxytocin peptide for use in the methods described herein
can be natural or synthetic, therapeutically or prophylactically
active, peptide fragments, peptide analogues, and chemically
modified derivatives or salts of active peptides. There are
processes described for the production of oxytocin, see for example
U.S. Pat. Nos. 2,938,891 and 3,076,797; in addition, oxytocin is
commercially available. A variety of peptide analogues and
derivatives are available and others can be contemplated for use
within the present disclosure and can be produced and tested for
biological activity according to known methods. Oxytocin analogues
may be included, but are not limited to,
4-threonine-1-hydroxy-deaminooxytocin, 4-serine,
8-isoleucine-oxytocin, 9-deamidooxytocin, 7-D-proline-oxytocin and
its deamino analog, (2,4-diisoleucine)-oxytocin, deamino oxytocin
analog, 1-deamino-1-monocarba-E12-Tyr(OMe)]-OT(dCOMOT), carbetocin,
4-threonine, 7-glycine-oxytocin (TG-OT), oxypressin,
deamino-6-carba-oxytoxin (dC60), L-371,257 and the related series
of compounds containing an ortho-trigluoro-ethoxyphenylacetyl core
such as L-374,943. Oxytocin peptides for use within the present
disclosure can be peptides that are obtainable by partial
substitution, addition, or deletion of amino acids within a
naturally occurring or native peptide sequence. Peptides can be
chemically modified, for example, by amidation of the carboxyl
terminus (--NH.sub.2), the use of D amino acids in the peptide,
incorporation of small non-peptidyl moieties, as well as the
modification of the amino acids themselves (e.g. alkylation or
esterification of side chain R-groups). Such analogues, derivatives
and fragments should substantially retain the desired biological
activity of the native oxytocin peptide.
Routes and Ranges of Administration of Oxytocin
[0058] The route of administration of oxytocin will depend upon the
age, weight and/or the physical condition of the patient and timing
of administration. In various embodiments, oxytocin can be
administered to a patient nasally, orally, intravenously,
intradermally, transdermally, subcutaneously, intramuscularly,
topically, intrathecally and intracerebroventricularly.
[0059] In one embodiment, oxytocin is administered nasally or
intranasally. Intranasal delivery has a number of advantageous
features including comparatively high bioavailability, rapid
kinetics of absorption and avoidance of a first-pass effect in the
liver. In regard to patient compliance and ease of use, intranasal
administration provides a simple, rapid and non-invasive mode of
application. Oxytocin or a pharmaceutical composition comprising
oxytocin can be administered to the nasal cavity as a powder, a
granule, a solution, a cream, a spray, a gel, a film, an ointment,
an infusion, a drop or a sustained-release composition. In one
embodiment, oxytocin or a pharmaceutical composition comprising
oxytocin can be administered intranasally using the CPAP inhalation
system. In these embodiments, oxytocin can be vaporized or
aerosolized and provided via the CPAP inhalation system
continuously or at regular intervals.
[0060] A therapeutically effective dose of oxytocin will depend
upon the age, weight and/or the physical condition of the patient
and route of administration. In some embodiments, the effective
dose of oxytocin may range from about 10-60 IU, 20-50 IU, or 25-45
IU per day. In some embodiments, the effective dose of oxytocin is
about 10, 15, 20, 25, 30, 35, 40, 45, 50, 55, or 60 IU per day. In
one embodiment, the effective dose of oxytocin is at least 40 IU
per day. In another embodiment, the effective dose of oxytocin is
at least 40 IU every other day. In yet another embodiment, the
effective dose of oxytocin is about 25 or 30 IU per day. In yet
another embodiment, the effective dose of oxytocin is at least 25
or 30 IU every other day. In some embodiments, the effective dose
of oxytocin is administered weekly. In some embodiments, the
therapeutically effective dose of oxytocin is not 10 units
administered at the time of sleep or over a 7 hour period. In some
embodiments, the therapeutically effective dose of oxytoxin is not
administered intramuscularly or intravenously.
[0061] The effective dose of oxytocin can be administered in a
single dose or in multiple doses, for example, dosages can be
administered two, three, four, five, six, seven, eight, nine or ten
times daily. In one embodiment, the effective dose of oxytocin is
40 IU and is administered as a one-time nasal spray shortly before
sleeping or within an hour of the patient falling asleep.
[0062] Preferably, oxytocin is administered closer to the sleeping
time or over the duration of sleep. For instance, in one
embodiment, the effective dose of oxytocin can be administered
about 10, 20, 30, 40, 50 minutes or about an hour prior to
sleeping. In another embodiment, the effective dose of oxytocin can
be administered within about 10, 20, 30, 40, 50 minutes or about an
hour of the patient falling asleep. In some embodiments, the
effective dose of oxytocin is administered as a single dose via the
CPAP inhalation system within an hour of the patient falling
asleep. In some other embodiments, the effective dose of oxytocin
is administered via the CPAP inhalation system over the duration of
sleep either continuously or at regular intervals.
Treatment of OSA Induced Cardiorespiratory Diseases
[0063] OSA represents a major, yet poorly understood cardiovascular
risk factor in .about.24% of males and 9% of females within the US
population. Severe OSA increases cardiovascular mortality 4 fold,
and even when corrected for other risk factors increases
cardiovascular mortality 3 fold. OSA can play a role in both the
initiation and progression of several
cardiovascular/cardiorespiratoty diseases including sudden death,
hypertension, arrhythmias, myocardial ischemia and stroke.
[0064] Prior studies by the inventors have shown that activation of
oxytocin-positive PVN neurons decreases resting heart rate (HR) and
blood pressure (BP). However, the activation of oxytocin-positive
PVN neurons does not necessarily indicate that oxytocin is the
mediator of the observed decrease in HR and BP. These oxytocin
neurons secrete many chemicals at their synapse, including fast
neurotransmitters. Prior work has shown these oxytocin neurons
release the fast neurotransmitter glutamate, and activation of
postsynaptic NMDA and AMPA glutamate receptors are primarily
responsible for the excitation of cardiac vagal neurons (Pinol et
al., 2014). While anatomical work has shown the presence of
peptides, including oxytocin, in the projections from the PVN to
parasympathetic nuclei, prior work has not demonstrated the release
of peptides either in replacement of, or in addition to, fast
neurotransmitters (such as glutamate), and electrophysiological
studies to date have only demonstrated release of glutamate and
activation of fast ligand gated receptors in these pathways (Pinol
et al., 2014). The present disclosure shows for the first time that
activation of oxytocin-positive PVN neurons evokes endogenous
release of oxytocin that is diminished with CIH/H, and that
selective activation of oxytocin-secreting PVN neurons during CIH/H
exposure both restores oxytocin release and prevents the
CIH/H-elicited elevations in BP to hypertensive levels that occurs
in untreated animals. That is, the present disclosure shows for the
first time that there is release of oxytocin from
oxytocin-secreting PVN neurons, and that this release of oxytocin
is cardio-protective. The present disclosure also shows that
administration of oxytocin in OSA patients decreases the duration
of apnea and the arterial oxygen desaturation that occurs during
hypoxia/hypercapnia episodes in OSA patients further confirming the
cardio-protective role of oxytocin in OSA patients.
[0065] In one embodiment, the present disclosure provides a method
for treating a patient suffering from OSA induced cardiorespiratory
disease, comprising administering to the patient an effective dose
of oxytocin. In one embodiment, the effective dose of oxytocin is
40 IU and is administered intranasally within an hour of the
patient falling asleep. OSA induced cardiorespiratory diseases that
may be treated in accordance with the present disclosure include,
but are not limited to, hypertension, cardiac arrhythmias,
myocardial ischemia, sudden cardiac death and stroke. The
aforementioned method of treating a patient population for
cardiorespiratory disease via oxytocin treatment is very surprising
given the fact that previous electrophysiological studies have only
demonstrated release of glutamate and activation of fast ligand
gated receptors in the PVN to parasympathetic nuclei pathways. See,
supra, FIG. 1 and Pinol et al., 2014. The inventors have therefore
discovered a unique method of treating a heretofore unidentified
patient population.
[0066] In one aspect, the present disclosure provides a method for
treating a patient suffering from OSA induced hypertension,
comprising administering to the patient an effective dose of
oxytocin. In one embodiment, the effective dose of oxytocin is at
least 40 IU and is administered intranasally within an hour of the
patient falling asleep.
[0067] In another aspect, the present disclosure provides a method
for treating a patient suffering from OSA and/or OSA induced
hypertension and compromised sleep quality, comprising activating
oxytocin-secreting PVN neurons in the patient.
[0068] In some embodiments, the patient being treated with oxytocin
for OSA induced cardiorespiratory diseases may also be receiving
CPAP therapy.
[0069] In one embodiment, administration of oxytocin reduces the
hypertension experienced by the patient. In another embodiment,
administration of oxytocin decreases the heart rate and/or blood
pressure of the OSA patient compared to the heart rate and/or blood
pressure prior to the treatment with oxytocin. In some embodiments,
administration of oxytocin decreases the heart rate and/or blood
pressure of the OSA patient by at least 10%, 15%, 20%, 25%, 30%,
35%, 40%, 45%, or 50% compared to the heart rate and/or blood
pressure prior to the treatment with oxytocin.
[0070] In one embodiment, administration of oxytocin prevents the
heart rate and/or blood pressure of the OSA patient from
increasing, i.e. oxytocin maintains the heart rate and/or blood
pressure to the levels normally found in the patient.
[0071] In certain embodiments, administration of oxytocin to a
patient suffering from OSA induced cardiorespiratory disease
reduces the oxygen desaturation experienced by the patient during
apnea episodes. The term "oxygen desaturation" as used herein
refers to a decrease in blood oxygen levels from a normal value of
.about.95 percent. In one embodiment, administration of oxytocin
reduces the oxygen desaturation experienced by the patient by at
least 2%, 3%, 4%, 5%, 6%, 7%, 8%, 9%, 10%, 15%, 20%, 25%, 30%, 35%,
40%, 45%, or 50% compared to the oxygen desaturation prior to the
treatment with oxytocin.
Methods of Improving Sleep Quality in OSA Patients
[0072] Previous studies have shown that different routes of
administration of oxytocin, for example, externally icy
administered oxytocin represented a stressful event and induced
arousal and did not promote sleep. For example, Lancel et al.
(Regulatory Peptides, 2003, 114: 145-152) showed in rats under
basal, stress-free conditions, endogenous oxytocin promotes sleep
whereas acute icy infusion of oxytocin delayed sleep onset latency,
which resulted in a transient reduction of non-REMS and REMS, and
augmented high-frequency activity in the electroencephalogram (EEG)
within non-REMS. Lancel et al. concluded that external icy
administration of oxytocin reflected a condition of stress and was
accompanied by behavioral arousal and increase vigilance.
[0073] Sleep apnea is a stressful event as it represents a strong
adverse challenge to the cardiorespiratory system that impedes the
breathing process necessary to supply oxygen to the rest of the
body. The present disclosure, however, unexpectedly found that, in
contrast to previous studies, external administration of oxytocin
to OSA patients improved sleep quality or sleep satisfaction in
these patients. Accordingly, in one embodiment, the present
disclosure provides methods for improving sleep quality in a
patient suffering from OSA, comprising administering to the patient
an effective dose of oxytocin. In one embodiment, the effective
dose of oxytocin is at least 40 IU and is administered intranasally
within an hour of the patient falling asleep. The aforementioned
method of improving sleep quality is counterintuitive in view of
references such as the above cited Lancel, et al. and represents a
significant advancement in sleep medicine.
[0074] In one embodiment, administration of oxytocin to OSA
patients decreases the number of arousals per hour experienced by
the patient leading to better sleep. "Arousals" are defined as
"abrupt changes in EEG frequency, which last for .gtoreq.3 seconds,
and are preceded by at least 10 seconds of EEG sleep." Frequency of
arousals is denoted by "arousal index" (arousals/hour) and
correlates positively with feelings of non-refreshing sleep, i.e.
higher the arousal index, more likely the patient will complain of
non-refreshing sleep. In some embodiments, administration of
oxytocin to OSA patients decreases the number of arousals per hour
experienced by the patient by at least 10%, 15%, 20%, 25%, 30%,
35%, 40%, 45%, or 50% compared to the number of arousals per hour
prior to the treatment with oxytocin.
[0075] In some embodiments, the quality of sleep or sleep
satisfaction in OSA patients is assessed by asking the patients to
rank their responses on the scale of 1-5 to a set of empirical
factors. For instance, in one embodiment, a set of empirical
factors includes the following parameters or questions: [0076] I
feel more refreshed than usual this morning [0077] My quality of
sleep last night was better than usual [0078] I slept deeper than
usual last night [0079] I woke up fewer times than usual last night
[0080] I slept longer than usual last night [0081] I feel better
overall than usual this morning The patients are asked to rank
their response to the above empirical factors on the scale of 1-5
as follows: [0082] 1--Strongly disagree [0083] 2--Slightly disagree
[0084] 3--Neither agree nor disagree [0085] 4--Slightly agree
[0086] 5--Strongly agree Based on their responses, a sleep score
for each patient is calculated. In one embodiment, administration
of oxytocin to OSA patients leads to improvement in empirical
factors or sleep score indicative of sleep quality in the OSA
patient.
[0087] In one embodiment, administration of oxytocin to OSA
patients decreases the duration of apnea experienced by the
patients leading to better sleep. In one embodiment, administration
of oxytocin to OSA patients reduces the duration of apnea by at
least 10%, 15%, 20%, 25%, 30%, 35%, 40%, 45%, 50%, 55%, 60%, 65%,
or 70% compared to the duration prior to the oxytocin
treatment.
Pharmaceutical Compositions
[0088] While it is possible to administer oxytocin alone, there may
be situations wherein it is advantageous to present it as part of a
pharmaceutical composition. Thus, in some aspects of the present
invention, oxytocin is administered as a pharmaceutical
composition. The pharmaceutical composition can comprise oxytocin
at a therapeutically effective dose together with one or more
pharmaceutically acceptable carriers and optionally other
ingredients. A suitable carrier is one which does not cause an
intolerable side effect, but which allows oxytocin to retain its
pharmacological activity in the body. A carrier may also reduce any
undesirable side effects of oxytocin. A suitable carrier should be
stable, i.e., incapable of reacting with other ingredients in the
formulation. A suitable carrier should have minimal odor or
fragrance or a positive (pleasant) odor. A suitable carrier should
not irritate the mucosa, epithelium, underlying nerves or provide a
health risk. It may be an accepted transcutaneous or percutaneous
carrier or vehicle, because any carrier that can effectively
penetrate the stratum corneum of the skin should be highly
efficacious in not only penetrating mucosa, but also allowing rapid
absorption of substances into the submucosal tissues, nerve sheaths
and nerves.
[0089] Suitable nontoxic pharmaceutically acceptable carriers will
be apparent to those skilled in the art of pharmaceutical
formulations. Also see Remington: The Science and Practice of
Pharmacy, 20th Edition, Lippincott, Williams & Wilkins (2000).
Typical pharmaceutically acceptable carriers include, but are not
limited to, mannitol, urea, dextrans, lactose, potato and maize
starches, magnesium stearate, talc, vegetable oils, polyalkylene
glycols, ethyl cellulose, poly(vinylpyrrolidone), calcium
carbonate, chitosan, ethyl oleate, isopropyl myristate, benzyl
benzoate, sodium carbonate, gelatin, potassium carbonate, silicic
acid, and other conventionally employed acceptable carriers. Other
carriers include, but are not limited to, phosphatidylcholine,
phosphatidylserine, and sphingomyelins.
[0090] The choice of a suitable carrier will depend on the exact
nature of the particular formulation desired, e.g., whether the
drug is to be formulated into a liquid solution (e.g., for use as
drops, for use in an injection, as a spray or impregnated in a
nasal tampon, or other agent-impregnated solid), a suspension, a
ointment, a film or a gel. If desired, sustained-release
compositions, e.g. sustained-release gels, films, transdermal
patchs, etc. can be readily prepared. The particular formulation
will also depend on the route of administration. In one embodiment,
a composition comprising oxytocin can be administered to the nasal
cavity as a powder, a granule, a solution, a cream, a spray, a gel,
a film, an ointment, an infusion, a drop or a sustained-release
composition.
[0091] To enhance delivery into or across the nasal mucosal surface
and/or absorption of a pharmaceutical composition comprising
oxytocin, an absorption-enhancing agent can be included in the
formulation. These enhancing agents may enhance the release or
solubility (e.g., from a formulation delivery vehicle), diffusion
rate, penetration capacity and timing, uptake, residence time,
stability, effective half-life, peak or sustained concentration
levels, clearance and other desired mucosal delivery
characteristics (e.g., as measured at the site of delivery) of the
composition. Absorption enhancing compounds may include, but are
not limited to, surfactants, bile salts, dihydrofusidates,
bioadhesive agents, phospholipid additives, mixed micelles,
liposomes, or carriers, alcohols, enamines, cationic polymers, NO
donor compounds, long-chain amphipathic molecules, small
hydrophobic penetration enhancers; sodium or a salicylic acid
derivatives, glycerol esters of acetoacetic acid, cyclodextrin or
beta-cyclodextrin derivatives, medium-chain fatty acids, chelating
agents, amino acids or salts thereof, N-acetylamino acids or salts
thereof, mucolytic agents, enzymes specifically targeted to a
selected membrane component, inhibitors of fatty acid synthesis and
inhibitors of cholesterol synthesis.
[0092] This disclosure is further illustrated by the following
additional examples that should not be construed as limiting. Those
of skill in the art should, in light of the present disclosure,
appreciate that many changes can be made to the specific
embodiments which are disclosed and still obtain a like or similar
result without departing from the spirit and scope of the
disclosure.
EXAMPLES
Example 1
[0093] Labeling of CVNs: To obtain electrophysiological recordings
from CVNs, neonatal Sprague-Dawley rats (postnatal days 2-5,
Hilltop Laboratory animals Inc, Scottdale, Pa., USA) were
anesthetized using hypothermia by cooling to approximately
4.degree. C. A right thoracotomy was performed and retrograde
tracer X-Rhoda-mine-5-(and-6)-isothiocyanate (Invitrogen, USA) was
then injected into the fat pads at the base of the heart to
retrogradely label CVNs (Mendelowitz & Kunze 1991). The animals
were then allowed to recover until they were 3-4 weeks old.
[0094] Telemetry Implantation: To record blood pressure and heart
rate, male Sprague-Dawley rats, 3-4 weeks of age, were anesthetized
using isoflurane (2-4%) and a HD-X11 pressure transmitter was
implanted (Data Sciences International, St Paul, Minn., USA) with
its cathether inserted into the abdominal aorta to record pressure
and EKG leads were attached subcutaneously to obtain EKG recordings
and heart rate. All rats with telemetry devices were allowed 7-14
days to recover from transmitter implantation surgery before any
measurements were recorded. Blood pressure and heart rate were
recorded via radio-frequency signals obtained through the Ponemah
data acquisition system (Data Sciences International). Baseline
recordings of blood pressure and heart rate were obtained for 3
days prior to CIH/H exposure. Prior to, and during, the 28 day
CIH/H exposure period daily baseline recordings of blood pressure
and heart rate were recorded.
[0095] Air or CIH/H exposure: Animals were exposed to repetitive
cycles of 3 minutes of mild H/H (6% O.sub.2+5% CO.sub.2+89%
N.sub.2) followed by 3 minutes of normoxia (21% O.sub.2+79%
N.sub.2), repeated for 10 times per hour, 8 hr/day, for 3 or 4
weeks. The animals were exposed to CIH/H for 8 hours during light
phase and to normal air during the remaining 16 hr. Unexposed
animals that were exposed to normal air (21% O.sub.2+79% N.sub.2),
were placed adjacent to the chambers during the exposure period to
undergo similar handling, general lab conditions, and background
noise as the CIH/H group.
[0096] In vitro brainstem slice preparation: The methodology
described by Ye and colleagues (Ye et al. 2006) was used to obtain
viable brainstem slices from mature animals. According to this
method, glycerol base artificial cerebrospinal fluid (aCSF) was
used for cardiac perfusion and brainstem slicing. Glycerol-based
aCSF contained (in mM): 252 glycerol, 1.6 KCl, 1.2
NaH.sub.2PO.sub.4, 1.2 MgCl, 2.4 CaCl.sub.2, 26 NaHCO.sub.3, and 11
glucose. Immediately following air or CIH/H exposure for 4 weeks,
rats were anaesthetized using isoflurane and placed on ice.
Glycerol aCSF (4.degree. C., pH: 7.4, bubbled with 95% O.sub.2-5%
CO.sub.2) was perfused transcardially at a speed of .about.10
ml/min after which the brain was quickly removed, glued on to a
stage using 2% low melt agarose and placed in a vibrotome
containing glycerol aCSF. Brainstem slices (330 .mu.m thickness)
containing either DMNX or NA or brainstem slices containing dorsal
motor nucleus (DMV) and channelrhodopsin (ChR2)-containing PVN
fibers were obtained and briefly placed in a solution with
following composition (in mM): 110 N-methyl-d-glucamine (NMDG), 2.5
KCl, 1.2 NaH.sub.2PO.sub.4, 25 NaHCO.sub.3, 25 glucose, 110 HCl,
0.5 CaCl.sub.2, and 10 MgSO.sub.4 equilibrated with 95% O.sub.2 and
5% CO.sub.2 (pH 7.4) at 34.degree. C. for 1 5 min. NMDG based aCSF
was used to help slices recover and to maintain viable brainstem
slices for electrophysiological recordings (Zhao et al. 2011). The
slices were then mounted in a recording chamber constantly perfused
with a normal aCSF with following composition (in mM): 125 NaCl, 3
KCl, 2 CaCl.sub.2, 26 NaHCO.sub.3, 5 glucose and 5 HEPES;
oxygenated with 95% O.sub.2-5% CO.sub.2 (pH-7.4) and allowed to
recover for at least 30 minutes before an experiment was
performed.
[0097] Electrophysiological recordings: CVNs in NA and DMNX were
identified by the presence of fluorescent tracer rhodamine and
imaged using differential interference contrast optics and infrared
illumination. Whole cell voltage clamp recordings from CVNs were
done using Axopatch 200B and pClamp 8 software (Axon Instruments,
Union city, USA), at a holding voltage of -80 mV at room
temperature. The patch pipettes (2.5-5 M.OMEGA.) were filled with a
solution consisting (in mM) of KCl (150), MgCl.sub.2 (4), EGTA
(10), Na-ATP (2) and HEPES (10) or K-gluconic acid (150), HEPES
(10), EGTA (10), MgCl.sub.2 (1) and CaCl.sub.2 (1) at a pH of 7.3
for recording inhibitory or excitatory events respectively. For PVN
studies, forebrain slices were used for electrophysiology
recordings.
[0098] Drugs were focally applied to CVNs using a pneumatic
picopump pressure delivery system. GABAergic inhibitory post
synaptic currents (IPSCs) were isolated by focal application of
solution containing strychnine (1 .mu.M, glycine receptor
antagonist), 6-cyano-7-nitroquinoxaline-2,3-dione (CNQX, 50 .mu.M,
non-NMDA receptor antagonist) and D-2-amino-5-phosphonovalerate
(AP5, 50 .mu.M, NMDA receptor antagonist), with the puffer pipette
positioned near the patched neuron. Glycinergic IPSCs were isolated
by including gabazine (25 .mu.M, GABA-A receptor antagonist), CNQX,
and AP5 in the puffer pipette. The puffer pipette was filled with
gabazine and strychnine to isolate glutamatergic excitatory
postsynaptic currents (EPSCs).
[0099] Acute H/H: The respective EPSCs or IPSCs were recorded in
control conditions for 5 min in the presence of aCSF equilibrated
with 95% O.sub.2+5% CO.sub.2. Brainstem slices containing CVNs were
exposed to H/H by superfusing the aCSF equilibrated with 85%
N.sub.2+6% O.sub.2+9% CO.sub.2 for 10 min. Gabazine, strychnine, or
CNQX, and AP5 were applied at the end of each experiment to confirm
the targeted isolation of GABAergic, glycinergic, or glutamatergic
activity, respectively. Each slice was exposed to hypoxia only once
limiting the experiments to only one CVN per slice of tissue.
Gabazine, strychnine, CNQX, and AP5 were obtained from Sigma
Aldrich (St. Louis, Mo., USA).
[0100] Viral vectors, plasmids, and promoter constructs: Lentiviral
plasmids pLenti-Syn-hChR2(H134R)-EYFP-WPRE, packaging plasmid
pCMV-.DELTA.R8.74 and envelope plasmid pMD2.G were all kindly
donated by K. Deisseroth (Stanford University, Stanford, Calif.,
USA). The pLenti-Syn-hChR2(H134R)-EYFP-WPRE viral vector was
produced according to customary protocols as described before (Wsol
et al., 2009).
[0101] A rat minimal oxytocin (OXT) promoter element from -530 bp
to +33 relative to the origin of transcription of the OXT gene
(UCSC genome browser on rat November 2004 assembly;
chr3:118,193,690 to 118,194,252) was synthesized de novo and
flanked by multiple cloning sites (Genscript, Piscataway, N.J.)
(McCann et al., 2002; Petersson et al., 1996). The rAAV1-OXT-Cre
was produced using the OXT promoter fragment in the following way
(MIT, Viral Gene Transfer Core): pFB-AAV-OXT promoter Cre was
created by cloning the OXT promoter into V032 by excising the OXT
promoter/pUC57 with XbaI (5') and AgeI (3') and cloning it into
V032 cut with SpeI (5') and AgeI (3'). Then Cre was added by
cutting Cre out of pBS185 with XhoI (5') and MluI-blunt (3') and
moving it into pFB-AAV-OXT cut with XhoI (5') and Asp718-blunt
(3'). To achieve robust and highly selective expression of designer
receptors exclusively activated by designer drugs (DREADDs) in PVN
OXT neurons, the reporter viral vector
AAV2-hSyn-DIO-hM.sub.3D(G.sub.q)-mCherry (UNC, Gene Therapy Center,
Vector Core Services) was co-injected with AAV-OXT-Cre. Expression
of these Cre-dependent vectors will only be initiated in neurons
selectively expressing Cre as they contain silencing double-floxed
inverse open reading frames (Sawchenko and Swanson, 1982). OXT
receptors, as well as the red fluorescent calcium indicator, were
expressed in Chinese hamster ovary (CHO) cells as previously
described (Gamer and Buchel, 2012).
[0102] Stereotactic injections: Stereotactic injections were
performed as previously described (Bradley and Floras, 2009; Parish
and Somers, 2004; Pinol et al. 2014).
pLenti-Syn-hChR2(H134R)-EYFP-WPRE (90-100 nl) was injected for
experiments involving activation of channelrhodopsin
(ChR2)-expressing PVN fibers, while 20-30 nl of viral vectors
rAAV1-OXT-Cre and AAV2-hSyn-DIO-hM.sub.3D(G.sub.q)-mCherry at a 1:2
ratio was injected for PVN OXT neuron activation.
[0103] Calcium imaging in OXT receptor-expressing CHO cells:
Visualization of CHO cells expressing OXT receptors and the calcium
indicator, as well as ChR2-containing PVN fibers, were performed on
a confocal microscope system as previously described (Gamer and
Buchel, 2012). To examine activation of OXT receptors upon
optogenetic activation of ChR2-expressing PVN fibers in the DMV,
CHO cells were pipetted onto the dorsal motor nucleus (DMV) of
brain stem slices from animals previously injected with
pLenti-Syn-hChR2(H134R)-EYFP-WPRE into the PVN. OXT-sensitive CHO
cells within the boundaries of the DMV and in close apposition to
ChR2-containing PVN fibers (7.5.+-.0.5 .mu.m) were used for
experiments.
[0104] Daily activation of DREADDs: 1-2 weeks after telemetry
implantation, DREADDs receptors on PVN OXT neurons were activated
daily by intraperitoneal (IP) injection of clozapine-n-oxide (CNO,
1.0 mg/kg). To investigate the effects of CNO on resting BP and HR
in both DREADDs-expressing and sham animals, 3 days prior to CIH/H
exposure (control days) baseline BP and HR values were recorded for
a 20 min period before CNO injection. Animals from each group then
received an IP injection of CNO, BP and HR were recorded for 1 hr,
and the animals then underwent exposure to air for 8 hr to achieve
acclimation to the chambers. During the 21 days of CIH/H exposure,
baseline recordings of BP and HR were obtained before CNO
injection, recorded for 1 hr post CNO injection, and for the entire
duration of CIH/H exposure.
[0105] Data Analysis for studies directed to the effects of CIH/H
on CVNs: Synaptosoft software (version 6.0.3; Synaptosoft, Decatur,
Ga.) was used to analyze the synaptic events recorded from CVNs.
Threshold value was set to the root mean square of noise levels
multiplied by 5. The frequency and amplitudes of synaptic currents
were grouped in 10 sec bins and averaged for 2 min at the end of
control and H/H. The data were presented as mean.+-.SEM. To examine
the chronic changes in blood pressure and heart rate over the 28
day CIH/H exposure, daily values recorded before each CIH/H
exposure were statistically analyzed by One-way repeated-measures
analysis of variance (One-way ANOVA) followed by Bonferroni's
multiple comparison test. Students unpaired t-test was used to
compare statistical significance between unexposed and CIH/H
exposed groups. For acute H/H evoked blood pressure and heart rate
responses during CIH/H exposure and in-vitro experiments utilizing
different conditions in the same CVN, Student's paired t-test was
used to test the significance using Graphpad Prism 5 software (La
Jolla, Calif., USA). Data with p<0.05 was considered
significant; in the figures, * denotes p<0.05, ** denotes
p<0.01, *** denotes p<0.001.
[0106] Data Analysis for studies directed to the effects of CIH/H
on PVNs: Calcium responses in CHO cells were grouped into 0.5 sec
bins for a total of 10 bins with the 3.sup.rd bin (time 0)
representing the time of ChR2-expressing PVN fiber activation.
Results are presented as percent control and statistically compared
with data from the same experiment using a one-way ANOVA with
repeated-measures followed by Bonferroni's multiple comparison
test. For those experiments comparing CHO cell responses in
unexposed brainstem tissue to CIH/H exposure, a one-way ANOVA was
used. Data with p<0.05 was considered significant.
[0107] Changes in the action potential firing frequency were
determined using the MiniAnalysis version 6.0.3 software
(Synaptosoft, Decatur, Ga.) and grouped into 5 min bins for a total
of 12 bins with the 2.sup.nd bin representing the start of CNO
application. Results are presented as means.+-.SE and statistically
compared with control data from the same experiment using a one-way
ANOVA with repeated-measures followed by Bonferroni's multiple
comparison test for all experiments. Data with p<0.05 were
considered significant.
[0108] To examine the effects of CNO on and the chronic changes to
mean arterial blood pressure (MAP) over the 21 days of CIH/H
exposure, values were recorded before and after CNO injection on
control days prior to CIH exposures, and days 1, 3, 6, 9, 12, 15,
18, and 21 of CIH/H. Changes within the DREADDs-expressing animals
and the sham animals were statistically analyzed by one-way ANOVA
with repeated-measures followed by Bonferroni's multiple comparison
test. To examine the statistical changes in MAP between the two
groups of animals, a two-way ANOVA with repeated-measures followed
by Bonferroni's multiple comparison test was used. Data with
p<0.05 were considered significant.
[0109] Software used for all statistical analysis of the data
included Graphpad Prism 4.01 (Graphpad Software, San Diego,
Calif.), MicroCal Origin 7.0 (OriginLabs Corp, Nothhampton, Mass.)
and Microsoft Excel (Microsoft Corp., Redmond, Wash.).
Example 2: Effect of CIH/H on Blood Pressure
[0110] Adult rats (4 weeks old) were exposed to CIH/H for 8 hours
and to normal air during the remaining 16 hours for 3 weeks as
explained above. Blood pressure and heart rate was examined before
and throughout 28 days of CIH/H exposure. After 4 weeks of CIH/H,
systolic and diastolic pressure increased to hypertensive levels
(from a systolic pressure of 105.+-.4.0 mmHg at the onset of CIH/H
to 144.+-.3.0 mmHg after 28 days of CIH/H, n=6; p<0.05; One way
ANOVA, and diastolic pressure increased from 77.+-.1.0 mmHg to
110.+-.5.0 mmHg after 28 days of CIH/H, n=6; p<0.05; One way
ANOVA), see FIG. 2A.
Example 3: Acute H/H Evoked Blood Pressure and Heart Rate Responses
at the Start and End of CIH/H Exposure
[0111] At the beginning of the 28 days of CIH/H exposures, during a
single exposure to H/H, heart rate decreased by 25% (438.+-.15
beats/min in normoxia and 325.+-.21 beats/min in acute H/H; n=6;
p<0.05; paired t-test), and this decrease in heart rate occurred
without significant changes in blood pressure (99.+-.2 mmHg in
normoxia and 97.+-.3 mmHg in acute H/H; n=6; p>0.05; paired
t-test). However, at the end of 4 weeks of CIH/H exposure, acute
H/H evoked a significant increase in blood pressure (112.+-.7 mmHg
in normoxia and 123.+-.5 mmHg in acute H/H; n=6; p<0.01; paired
t-test) while there were no significant changes in heart rate
(389.+-.23 beats/min in normoxia and 353.+-.27 beats/min in acute
H/H; n=6; p>0.05; paired t-test), see FIGS. 2B and 2C.
Example 4: Actions of CIH/H on Inhibitory Neurotransmission to
CVNs
[0112] GABAergic and glycinergic IPSCs were examined from CVNs both
in the NA and DMNX of the brainstem from unexposed and CIH/H
animals. In unexposed animals, the frequency of both GABAergic
(7.9.+-.1.2 Hz, n=48 in NA and 3.5.+-.0.3 Hz, n=20 in DMNX;
p<0.05; Unpaired t-test) and glycinergic (4.4.+-.0.6 Hz, n=29 in
NA and 1.8.+-.0.2 Hz, n=27 in DMNX; p<0.001; Unpaired t-test)
IPSCs in NA CVNs was greater than that in DMNX CVNs, see FIGS. 3C,
3F, 4C, and 4F. In addition, the amplitude of glycinergic IPSCs in
CVNs of DMNX was significantly less than that of NA (58.6.+-.9.8
pA, n=29 in NA and 23.6.+-.1.5 pA, n=27 in DMNX; p<0.01;
Unpaired t-test). The amplitudes of GABAergic IPSCs in NA and DMNX
CVNs were not different (44.0.+-.2.5 pA, n=48 in NA CVNs and
46.6.+-.4.3 pA, n=20 in DMNX CVNs; p>0.05).
[0113] CIH/H exaggerated the frequency of GABAergic (but not
glycinergic) IPSCs in NA CVNs, whereas glycinergic (but not
GABAergic) IPSC frequency was increased in DMNX CVNs following
CIH/H. The frequency of GABAergic IPSCs recorded from NA CVNs of
CIH/H exposed animals was 49% greater than that in unexposed
animals (7.9.+-.1.2 Hz, n=48 in unexposed and 11.8.+-.1.3 Hz, n=51
in CIH/H exposed; p<0.05; unpaired t-test), FIGS. 3A-3C. In
DMNX, no change in GABAergic IPSC frequency to CVNs was observed
between unexposed and CIH/H exposed animal groups (3.5.+-.0.3 Hz,
n=20 in unexposed and 4.5.+-.0.7 Hz, n=25 in CIH/H exposed;
p>0.05; unpaired t-test), FIGS. 3D-3F. The amplitude of
GABAergic IPSCs to CVNs of NA and DMNX in unexposed group was not
different from that of CIH/H exposed group.
[0114] With respect to glycinergic IPSCs to CVNs, their frequency
and amplitudes in CIH/H and unexposed groups were not different in
NA CVNs. However, in DMNX CVNs, the frequency of glycinergic IPSCs
from CIH/H group was 50% greater compared to unexposed group
(1.8.+-.0.2 Hz, n=27 in unexposed and 2.7.+-.0.4 Hz, n=23 in CIH/H
exposed; p<0.05; unpaired t-test); see FIGS. 4A-4F.
Example 5: Actions of CIH/H on Excitatory Glutamatergic
Neurotransmission to CVNs
[0115] The amplitude of EPSCs in NA CVNs was significantly less
than the amplitude of EPSCs in DMNX CVNs (18.0.+-.1.8 pA, n=28 in
NA and 34.1.+-.1.9 pA, n=19 in DMNX; p<0.001; Unpaired t-test).
CIH/H significantly reduced the frequency of glutamatergic EPSCs in
CVNs in both NA (4.0.+-.0.4 Hz, n=28 in unexposed and 2.7.+-.0.3
Hz, n=24 in CIH/H exposed; p<0.01; unpaired t-test) and DMNX
(4.1.+-.0.3 Hz, n=17 in unexposed and 2.3.+-.0.3 Hz, n=18 in CIH/H
exposed; p<0.001; unpaired t-test) compared to unexposed group,
see FIGS. 5C and 5G-. CIH/H also reduced the amplitude of EPSCs in
DMNX, but not NA, CVNs (34.1.+-.3.2 pA, n=17 in unexposed and
25.8.+-.2.5 pA, n=18 in CIH/H exposed; p<0.05; unpaired t-test),
FIGS. 5D and 5H.
Example 6: Effect of Acute H/H on Inhibitory Neurotransmission to
CVNs in Unexposed Animals
[0116] GABA: In unexposed animals acute exposure to H/H inhibited
the frequency of GABAergic IPSCs by 40% and 60% in the NA and DMNX
CVNs respectively (NA CVNs: 6.3.+-.1.0 Hz in control and 3.7.+-.0.5
Hz in H/H; n=14; p<0.05; paired t-test, DMNX CVNs: 3.4.+-.0.5 Hz
in control and 1.3.+-.0.3 Hz in H/H; n=9; p<0.001; paired
t-test), see FIGS. 6B and 6E. In addition, H/H inhibited the
amplitude of GABAergic IPSCs in DMNX CVNs (52.5.+-.3.7 pA in
control and 42.4.+-.3.5 pA in H/H; n=9; p<0.05; paired t-test)
but not in CVNs within the NA, see FIGS. 6C and 6F.
[0117] Glycine: Acute H/H inhibited the frequency of glycinergic
IPSCs in DMNX CVNs by 50% (2.0.+-.0.3 Hz in control and 1.0.+-.0.2
Hz in H/H; n=12; p<0.01; paired t-test). However the frequency
and amplitude of glycinergic IPSCs in NA CVNs were unaltered by
acute H/H, see FIGS. 7A-7F.
Example 7: Effect of Acute H/H on Inhibitory Neurotransmission to
CVNs in CIH/H Exposed Animals
[0118] GABA: Similar to the responses in the unexposed group, in
animals exposed to CIH/H acute H/H inhibited the frequency of GABA
IPSCs in DMNX CVNs by 60% (4.5.+-.1.6 Hz in control and 1.3.+-.0.3
Hz in H/H; n=11; p<0.05; paired t-test), see FIG. 6K. In
contrast, in CIH/H animals the GABAergic responses to acute H/H on
NA CVNs was abolished (7.1.+-.1.2 Hz in control and 7.2.+-.1.5 Hz
in H/H; n=13; p>0.05; paired t-test), see FIGS. 6G-6I.
[0119] Similar to the responses in the unexposed animal group, in
animals exposed to CIH/H acute H/H reduced the amplitude of GABA
IPSCs in DMNX CVNs (42.3.+-.4.5 pA in control and 33.8.+-.3.1 pA in
H/H; n=11; p<0.05; paired t-test) but not in NA CVNs, see FIGS.
6I and 6L.
[0120] Glycine: Unlike the unexposed animals, in animals exposed to
CIH/H acute H/H significantly increased the frequency of
glycinergic IPSCs in NA CVNs by 40%, without any significant
changes in glycinergic IPSC amplitude (5.5.+-.0.9 Hz in control and
7.8.+-.0.9 Hz in H/H; n=12; p<0.05; paired t-test), see FIGS. 7H
and 7I. In animals exposed to CIH/H, acute H/H inhibited the
frequency of glycinergic IPSCs in DMNX CVNs by 25%; see FIG.
7K.
Example 8: Effect of Acute H/H on Glutamatergic Neurotransmission
to CVNs of Unexposed and CIH/H Exposed Animals
[0121] Acute H/H had no effect on the frequency or amplitude of
glutamatergic EPSCs to CVNs in NA and DMNX in both unexposed and
CIH/H exposed animals (Data not shown).
Example 9: Selectivity and In Vitro Activation of Excitatory
DREADDs in PVN OXT Neurons
[0122] Selective excitatory DREADDs expression in PVN OXT neurons
was achieved with injection into the PVN of two viral vectors, one
expressing Cre under an OXT promoter (rAAV1-OXT-Cre), and the other
a Cre-dependent vector expressing excitatory hM.sub.3D(G.sub.q)
DREADDs (AAV2-hSyn-DIO-hM.sub.3D(G.sub.q)-mCherry).
Immunohistochemical analysis confirmed that this viral expression
system elicited high (83.1.+-.2.1%) selectivity for DREADDs
expression in PVN OXT neurons. The responses upon activation of
DREADDs in PVN OXT neurons was assessed in vitro using the
whole-cell patch clamp method. The action potential firing
frequency of DREADDs-expressing PVN neurons significantly increased
within 5 min of CNO application (from 0.19.+-.0.05 Hz to
0.75.+-.0.14 Hz; n=7; *p<0.01; one-way ANOVA; FIGS. 8A-8B).
These experiments indicate that CNO application significantly
increases the firing of DREADDs-expressing PVN neurons.
Example 10: The Effects of CIH/H on OXT Receptor Activation
[0123] In order to examine if the release of OXT from PVN fibers is
altered with CIH/H, the responses in OXT-sensitive CHO cells were
examined in brainstem tissue from unexposed sham and CIH/H exposed
animals. Photoactivation of ChR2-containing PVN fibers in the DMV
of brainstem slices from unexposed animals evoked large,
reproducible, and transient increases in intracellular calcium
levels in OXT-sensitive CHO cells (average increases of
21.1.+-.0.02% from baseline during first second; n=14; *p<0.05;
one-way ANOVA with repeated measures; FIG. 9B, "sham animals"). CHO
cell responses upon PVN fiber stimulation in brainstem slices from
animals exposed to CIH/H was significantly depressed (average
increases of 8.1.+-.0.01% from baseline during first second; n=16;
*p<0.05; one-way ANOVA with repeated measures; FIG. 9B, "CIH/H
animals") compared to responses in unexposed animals
(.sup.+p<0.05; one-way ANOVA; FIG. 9B, "CIH/H animals"). These
results indicate the release of OXT from PVN fibers in the DMV is
significantly decreased following CIH/H exposure. To examine if
restoration of OXT neuron function during CIH/H could restore
responses in OXT-sensitive CHO cells, PVN OXT neurons were
activated daily before and during CIH/H by daily injections of CNO
to activate PVN OXT neurons via excitation of DREADDs receptors in
PVN OXT neurons. In animals with chronic activation of OXT neurons
the responses in OXT-sensitive CHO cells upon photostimulation of
ChR2-containing PVN fibers in the DMV were restored and not
significantly different from responses in air exposed control
animals (average increases of 23.4.+-.0.03% from baseline during
first second; n=17; *p<0.05; one-way ANOVA with repeated
measures; FIG. 9B,"CIH/H+OXT neuron activated animals"). These
restored responses in DREADDs-expressing animals were however,
significantly increased compared to CIH/H exposed animals
(.sup.+p<0.05; one way ANOVA; FIG. 9B, "CIH/H+OXT neuron
activated animals"). These data indicate that OXT released from PVN
fibers in the DMV is diminished with CIH/H, but that this release
can be restored with chronic PVN OXT neuron activation.
Example 11: Acute PVN OXT Neuron Activation Decreases Resting Blood
Pressure and Heart Rate
[0124] CNO administration had no effect on BP represented as mean
arterial pressure (MAP) and HR in sham animals without DREADDs
expression (FIGS. 10A and 10B). However, CNO administration that
activates DREADDs receptors in PVN OXT neurons decreased resting HR
and BP throughout 21 days of CIH/H exposure, with significant
decreases in MAP (104.+-.2.6 mmHg before CNO to 93.+-.1.7 mmHg
after CNO; n=8; .sup.+p<0.0001; paired t test; FIG. 10A) and HR
(416.+-.7.1 beats/min before CNO to 362.+-.10.5 beats/min after
CNO; n=8; .sup.+p<0.01; paired t test; FIG. 10B). These data
indicate that selective activation of PVN OXT neurons decreases
resting BP and HR in conscious unrestrained telemetry instrumented
animals.
Example 12: Activation of Oxytocin Neurons Blunts the Increase in
BP that Occur with to Hypoxia/Hypercapnia
[0125] Activation of oxytocin neurons also blunted the increase in
blood pressure that occurred with hypoxia/hypercapnia (FIG. 11).
Activation of oxytocin neurons was achieved by selective expression
and subsequent activation of the excitatory Designer Receptors
Exclusively Activated by Designer Drugs (DREADDs) virally expressed
in paraventricular hypothalamus oxytocin neurons upon
microinjection of both an adeno-associated (AAV) floxed DREADDS
virus and a lentivirus virus that selectively drives CRE expression
under the control of the oxytocin promoter.
Example 13: Chronic PVN OXT Neuron Activation Prevents the
Development of Hypertension that Occurs with CIH/H
[0126] To test if activation of PVN OXT neurons alters the changes
in BP that occur with CIH/H, MAP was examined before and throughout
21 days of CIH/H exposure in sham and OXT neuron activated animals.
After 3 weeks of CIH/H, MAP increased to hypertensive levels in
sham animals (from a MAP of 102.+-.3.3 mmHg on control days to
120.+-.0.5 mmHg on day 21; n=7; .sup.+p<0.01; one-way ANOVA with
repeated measures; FIG. 12). Interestingly, animals receiving daily
PVN OXT neuron activation experienced no significant changes in MAP
throughout the 21 days of CIH/H exposure (from a MAP of 104.+-.2.6
mmHg on control days to 103.+-.3.0 mmHg on day 21; n=8; p>0.05;
one-way ANOVA with repeated measures; FIG. 12). Animals in the sham
group experienced significant increases in MAP from day 12 through
day 21, whereas the increase in MAP was prevented in the
DREADDs-expressing animals (Day 12: MAP in sham group of 117.+-.4.1
mmHg, MAP in DREADDs-expressing group of 105.+-.2.6 mmHg; Day 15:
MAP in sham group of 118.+-.2.6 mmHg, MAP in DREADDs-expressing
group of 105.+-.3.1 mmHg; Day 18: MAP in sham group of 122.+-.1.1
mmHg, MAP in DREADDs-expressing group of 104.+-.2.9 mmHg; Day 21:
MAP in sham group of 120.+-.0.5 mmHg, MAP in DREADDs-expressing
group of 103.+-.3.0 mmHg; n=7 sham animals and 8 DREADDs-expressing
animals; *p<0.01; two-way ANOVA with repeated measures; FIG.
12). These data indicate that chronic activation of PVN OXT neurons
prevents the development of hypertension that occurs in sham
animals with CIH/H exposure.
Example 14: Administration of Oxytocin to Human Patients Improves
Sleep Quality and Shows Cardio-Protective Effect
[0127] Patients recently diagnosed with OSA were recruited to test
the effect of oxytocin administration on heart rate, apnea-hypopnea
index, oxygen saturation, apnea duration, arousal index etc. The
study is approved by the FDA (IND #120989). Patients were
administered 40 IU of oxytocin intranasally about one hour prior to
sleeping.
[0128] The following eight outcomes were compared in the same
patients prior to and after administration with oxytocin: [0129]
basal heart rate before sleep (primary outcome) [0130] mean changes
in heart rate with apneic and hypopneic events (primary outcome)
[0131] apnea-hypopnea index (secondary outcome) [0132] percentage
of time spent by the patient with oxygen saturations: >90%,
>80% but <90%, and <80% (secondary outcome) [0133]
duration of apneas [0134] oxygen desaturation during apneas
(expressed as adverse desaturations in percent oxygen) [0135]
numbers of arousals (expressed per hour) [0136] sleep quality
[0137] The following information was recorded for each patient
before and after the use of intranasal oxytocin: [0138] 1.
Demographics--Age, gender, ethnicity, weight, BMI. [0139] 2.
Physiological data: [0140] a. Basal heart rate before sleep [0141]
b. Apnea-hypopnea index [0142] c. Mean changes in heart rate with
apneic and hypopneic events [0143] d. Percentage of time spent by
the patient with oxygen saturations: >90%, >80% but <90%,
and <80%. [0144] e. Duration of apneas [0145] f. Oxygen
desaturation during apneas (expressed as adverse desaturations in
percent oxygen) [0146] g. Numbers of arousals (expressed per hour)
[0147] h. Sleep quality [0148] 3. Standard of care sleep study data
using PSG: Polysomnography (PSG) monitors many body functions
during sleep, including brain (EEG), eye movements (EOG), muscle
activity or skeletal muscle activation (EMG), heart rhythm (ECG),
respiratory airflow, thoracic and abdominal respiratory effort,
body position, limb movement, and oxygen saturation using pulse
oximetry. Recording and scoring was done according to the standards
set by the American Academy of Sleep Medicine. [0149] 4. Sleep
quality score: Patients were asked to rank their responses using
the scale of 1-5 for a set of empirical factors: [0150] 1--Strongly
disagree [0151] 2--Slightly disagree [0152] 3--Neither agree nor
disagree [0153] 4--Slightly agree [0154] 5--Strongly agree
Empirical Factors:
[0154] [0155] I feel more refreshed than usual this morning [0156]
My quality of sleep last night was better than usual [0157] I slept
deeper than usual last night [0158] I woke up fewer times than
usual last night [0159] I slept longer than usual last night [0160]
I feel better overall than usual this morning
[0161] The study shows that nasal administration of oxytocin
reduces the duration of apnea (FIG. 13), reduces oxygen
desaturation (FIG. 14), decreases the number of arousals/hour (FIG.
15), and improves sleep satisfaction (FIG. 16).
INCORPORATION BY REFERENCE
[0162] All references, articles, publications, patents, patent
publications, and patent applications cited herein are incorporated
by reference in their entireties for all purposes.
[0163] However, mention of any reference, article, publication,
patent, patent publication, and patent application cited herein is
not, and should not be taken as, an acknowledgment or any form of
suggestion that they constitute valid prior art or form part of the
common general knowledge in any country in the world.
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