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Biperiden Administration I)Uring REM Sleep Deprivation Diminished the Frequency of REM Sle1ep Attempts

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Biperiden Administration I)Uring REM Sleep Deprivation Diminished the Frequency of REM Sle1ep Attempts Sleep, 15(3):252-256 © 1992 American Sleep Disorders Association and Sleep Research Society Biperiden Administration I)uring REM Sleep Deprivation Diminished the Frequency of REM Sle1ep Attempts *tRafael1. Salin-Pascual, tDaniel Grandos-Fuentes, tLourdes Galicia-Polo, tEstela Nieves, Downloaded from https://academic.oup.com/sleep/article/15/3/252/2749274 by guest on 30 September 2021 *Timothy A. Roehrs and *Thomas Roth *Sleep Disorders Center, Henry Ford Hospital, Detroit, Michigan, U.S.A.; and tPsychobiological Department, Mexican Psychiatric Institute, Mexico City, Mexico Summary: Sixteen subjects were assigned to a group using either placebo or biperiden, with eight subjects in each group. Both groups were studied for one acclimatization night, one baseline night, four nights of rapid eye movement (REM) sleep deprivation and two recovery nights. All the subjects received either placebo or 4 mg biperiden I hour before sleep during the four nights of REM sleep deprivation. During the baseline and the recovery nights both groups received placebo capsules. The results showed that REM sleep time during thl~ REM sleep deprivation was reduced by 70-75% below the baseline night in both groups. The number of attempts to enter REM sleep was significantly reduced by biperiden as compared to placebo for each of the four REM sleep deprivation nights. Because the total sleep time in the biperiden group was reduced, the number of REM sleep attempts was corrected by the total sleep time. The adjusted number of REM sleep attempts was also significantly reduced in the biperiden group. REM sleep latency showed a reduction in the placebo group, whereas in the biperiden group REM sleep latency was unchanged throughout the deprivation nights. In the recovery night REM sleep time was increased in both groups, with no differences between the groups. The REM sleep latency showed a reduction in the first recovery night in both groups that persisted through the second recovery night. The above findings support the role of biperiden as a REM sleep suppressive drug. Key Words: Muscarinic receptors-REM sleep deprivation-Biperiden-Human subjects. It has been proposed that Ml and M2 muscarinic den did not show a significant increase in REM sleep. receptors as well as nicotinic receptors are involved in It was not until the follow-up night (with no active the regulatory process of rapid eye movement (REM) drug administration) that REM sleep increased in the sleep based on studies in cats (1-3) and humans (4,5). biperiden group. Another group has recently reported Biperiden is an anticholinergic drug with preference a dose-dependent inhibition of REM sleep in normal for Ml muscarinic receptors (6). Biperiden adminis­ volunteers by biperiden; they used 2-, 4-, and 8-mg tration in healthy normal humans increased REM sleep doses of biperiden and found a significant reduction latency at 4- and 6-mg doses and biperiden 6 mg re­ even with a 4-mg dose (8). duced REM sleep time (7). In the same study, after six The fact that biperiden modified REM sleep both nights of REM sleep deprivation two groups of normal on baseline and during recovery nights from REM sleep subjects received either placebo or biperiden (4 mg) on deprivation suggests that Ml receptors are involved in the first recovery night. The REM sleep time in the REM sleep mechanisms in humans. The fact that a group that received placebo was increased during the lower biperiden dose altered REM sleep more during recovery night, whereas the group that received biperi- deprivation recovery than on baseline nights might be explained as follows. Normally, acetylcholine is re­ leased during REM sleep as shown in the cat (9). REM Accepted for publication November 1991. sleep deprivation could modify the release of acetyl­ Address correspondence and reprint requests to Rafael J. Salin­ choline and change muscarinic receptor sensitivity, Pascual, M.D., D.MSc., U.e.S.D. Psychiatry Dept. and San Di(:go VA Medical Center-Psychiatry SVC (116 A), 3350 La Iolla Vi11age thereby producing the increased response to a low dose Dr., San Diego, California 92161, U.S.A. ofbiperiden and reduced REM sleep rebound. In sup- 252 BIPERIDEN AND REM SLEEP 253 port of the above idea, it has been reported (10) in tinuous minutes of sleep after lights out. Awake time human volunteers that physostigmine (an indirect cho­ was defined as the minutes awake after sleep onset. linomimetic drug) infusion after four nights of REM REM sleep latency was defined as the time from sleep sleep deprivation modifies the typical REM sleep re­ onset to the completion of two epochs of REM sleep covery. If the above is the case, the question arises as (1 minute) (including intermittent awakenings). A REM to whether the combination of REM sleep deprivation sleep attempt was defined as one epoch of continuous and biperiden administration might further reduce REM sleep. cholinergic activity by both suppressing acetylcholine Overall two-way ANOYAs, using group as one vari­ release and blocking receptors, thereby leading to a able (placebo group vs. biperiden group) and night as lessened pressure for REM sleep during deprivation. the second variable, were performed. Post-hoc Stu­ The present study was developed to examine in nor­ dents' t tests for repeated measures with a correction Downloaded from https://academic.oup.com/sleep/article/15/3/252/2749274 by guest on 30 September 2021 mal volunteers the effects of biperiden when admin­ to maintain the alpha level of significance at p < 0.05 istered simultaneously with REM sleep deprivation. (Bonferroni's correction) were performed when indi­ We were interested in biperiden effects during REM cated. sleep deprivation and in the recovery period when REM sleep rebound typically occurs. The main hypotheses RESULTS were that if biperiden blocks M 1 receptors and if they are involved in REM sleep, then biperiden should re­ Results of the overall two-way ANOYAs and post­ duce the number of REM sleep attempts during REM hoc tests are presented in Table 1. The means and sleep deprivation, and the drug also should produce a standard deviations of baseline and deprivation nights differential REM sleep rebound in comparison with and baseline and recovery nights are presented in Ta­ the placebo group. bles 2 and 3, respectively. REM sleep time on deprivation nights was reduced METHODS in both groups by 70-75% below baseline, with no differences between placebo or biperiden groups. Dur­ Sixteen healthy volunteers were studied [aged: 25.2 ing the recovery nights, this variable was increased ± 2.8 years (mean ± SD)]. All the subjects were between 28 to 30% without differences between the screened by the Diagnostic Interview Schedule in a groups (ANOYA-group effects: F = 0.43, df= 1,14, reliable Spanish version (11). They had no history of p = 0.51; night effects: F = 140.4, df = 6,79, p < psychiatric disorder, sleep disturbances or serious ill­ 0.00001; interactions: F= 0.255, df= 6,79, p = 0.95). ness. The subjects were nonsmokers and had,no history REM sleep latency on deprivation nights was re­ of alcohol or other drug abuse. duced in the placebo group (vs. baseline), whereas in The subjects were randomly assigned to one of two the biperiden group it was increased (a trend indicated groups: placebo or biperiden, with eight subjects per by the interaction, p < 0.10). During recovery nights, group. Each volunteer slept in the laboratory on one a reduction in this variable was observed in both groups, acclimatization night, one baseline night, four REM with no differences between them (ANOYA-group sleep deprivation nights and two recovery nights. All effects: F = 5.83, df= 1,14, p < 0.01; night effects: F the subjects received identical capsules with either pla­ = 3.56, df = 6,79, p < 0.003; interactions: F = 1.8, df cebo or 4 mg biperiden (two commercial tablets of 2 = 6,79, p < 0.10). mg Akineton, Knoll), 1 hour before sleep during the The number of REM sleep attempts on REM sleep four nights of REM sleep deprivation. During the base­ deprivation nights was significantly increased in both line and recovery nights, both groups received placebo groups. But there was a reduced number of attempts capsules. For the four nights of REM sleep deprivation in the biperiden group in comparison with the other the volunteers were immediately awakened on every group (ANOYA-group effects: F = 27.7, df = 1,14, occasion when they showed polysomnographic evi­ p < 0.00001; night effects: F= 25.19, df= 6,79, p < dence of REM sleep (one epoch) by technicians who 0.00001; interactions: F = 4.4, df = 6,79, p < 0.001). did not know the treatment that the volunteers were Because the total sleep time was significantly reduced receiving. The sleep recordings started at 2200 hours in the biperiden group (ANOYA-group effects: F = and ran until 0600 hours. They were scored visually 13.03, df= 1,14, p < 0.00001; night effects: F = 27.7, according to standardized criteria (12) by one of us df = 6,79, p < 0.00001; interactions: F = 2.58, df = who was not informed of the experimental procedure 6,79, p < 0.02), the number of REM sleep attempts for each group. The subjects were not allowed to nap was corrected for the total sleep time differences (by during the day and were reminded of this restriction an index: number of REM sleep attempts/total sleep each morning. time). The resulting index was also significantly re­ Sleep onset was defined as the first epoch of 8 con- duced in the biperiden group. Sleep, Vol. 15, No.3, 1992 254 R. J. SALIN·PASCUAL ET AL.
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