Sleep apnea in young abstinent recreational MDMA ("ecstasy") consumers

Department of Psychiatry, The Johns Hopkins School of Medicine, Baltimore, MD 21224, USA.
Neurology (Impact Factor: 8.29). 12/2009; 73(23):2011-7. DOI: 10.1212/WNL.0b013e3181c51a62
Source: PubMed


Methylenedioxymethamphetamine (MDMA, "ecstasy") is a popular recreational drug of abuse and a selective brain serotonin neurotoxin. Functional consequences of MDMA neurotoxicity have defied ready characterization. Obstructive sleep apnea (OSA) is a common form of sleep-disordered breathing in which brain serotonin dysfunction may play a role. The present study sought to determine whether abstinent recreational MDMA users have an increased prevalence of OSA.
We studied 71 medically healthy recreational MDMA users and 62 control subjects using all-night sleep polysomnography in a controlled inpatient research setting. Rates of apneas, hypopneas, and apnea hypopnea indices were compared in the 2 groups, controlling for body mass index, age, race, and gender.
Recreational MDMA users who had been drug free for at least 2 weeks had significantly increased rates of obstructive sleep apnea and hypopnea compared with controls. The odds ratio (95% confidence interval) for sleep apnea (mild, moderate, and severe combined) in MDMA users during non-REM sleep was 8.5 (2.4-30.4), which was greater than that associated with obesity [6.9 (1.7-28.2)]. Severity of OSA was significantly related to lifetime MDMA exposure.
These findings suggest that prior recreational methylenedioxymethamphetamine use increases the risk for obstructive sleep apnea and lend support to the notion that brain serotonin neuronal dysfunction plays a role in the pathophysiology of sleep apnea.

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Available from: Alan R Schwartz, Jan 26, 2015
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    • "In addition to the neurocognitive effects of ecstasy use, psychobiological sleep dysfunction is emerging as a feature associated with regular ecstasy use. A growing body of evidence suggests that ecstasy use is associated with increased subjective and objective sleep disturbance that persists even after the subacute effects of the drug have worn off (Allen et al., 1993; Carhart-Harris et al., 2009; Jones et al., 2008; McCann et al., 2000, 2009; Montgomery et al., 2007; Ogeil et al., 2011). It is notable that users report ecstasy-related sleep problems at an equivalent frequency to ecstasy-related memory problems (in approximately 40% of 'moderate' users) (Parrott et al., 2002; Rodgers et al., 2006), indicating that sleep dysfunction is also a prominent consequence of ecstasy use. "
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    ABSTRACT: Sleep plays an important role in the consolidation and integration of memory in a process called overnight memory consolidation. Previous studies indicate that ecstasy users have marked and persistent neurocognitive and sleep-related impairments. We extend past research by examining overnight memory consolidation among regular ecstasy users (n=12) and drug naïve healthy controls (n=26). Memory recall of word pairs was evaluated before and after a period of sleep, with and without interference prior to testing. In addition, we assessed neurocognitive performances across tasks of learning, memory and executive functioning. Ecstasy users demonstrated impaired overnight memory consolidation, a finding that was more pronounced following associative interference. Additionally, ecstasy users demonstrated impairments on tasks recruiting frontostriatal and hippocampal neural circuitry, in the domains of proactive interference memory, long-term memory, encoding, working memory and complex planning. We suggest that ecstasy-associated dysfunction in fronto-temporal circuitry may underlie overnight consolidation memory impairments in regular ecstasy users.
    Full-text · Article · Mar 2014 · Journal of Psychopharmacology
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    • "Parrott's review never directly addresses the controversy surrounding the use of interspecies scaling in preclinical research (Baumann et al., 2007). In reference to long-term effects on sleep, a comparison reporting sleep interruption and respiratory disruptions described as sleep apnea (McCann et al., 2009), Parrott fails to mention that these results are not confirmed in at least two other studies, one of them of equal or superior design (Carhart-Harris et al., 2009; Randall et al., 2009) and he ignores the potential significance of smoking, polysubstance use, and male gender in producing relatively high levels of respiratory disruption in both ecstasy using and control groups (Al Lawati et al., 2009; Lin et al., 2012). Parrott devotes a section of the review to apoptosis, implying that the findings refer to cell death in human brain cells. "
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    ABSTRACT: Parrott recently published a review of literature on MDMA/ecstasy. This commentary is a response to the content and tenor of his review, which mischaracterizes the literature through misstatement and omission of contrary findings, and fails to address the central controversies in the literature. The review makes several erroneous statements concerning MDMA-assisted psychotherapy, such as incorrect statements about research design and other statements that are baseless or contradicted by the literature. Though it critiques an attempt by other authors to characterize the risks of MDMA, the review fails to produce a competing model of risk assessment, and does not discuss potential benefits. Parrott does not represent an even-handed review of the literature, but instead recites dated misconceptions about neurotoxicity concerns involving the recreational drug ecstasy, which do not relate directly to the use of pure MDMA in a therapeutic setting. Unchallenged, Parrott's report may deter researchers from further investigating an innovative treatment that in early clinical trials has demonstrated lasting benefits for people with chronic, treatment-resistant post-traumatic stress disorder. Copyright © 2014 John Wiley & Sons, Ltd.
    Full-text · Article · Mar 2014 · Human Psychopharmacology Clinical and Experimental
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    • "Neuroimaging studies of abstinent MDMA users reveal significantly lower levels of the serotonin transporter (SERT) (Erritizoe et al., 2011; Kish et al., 2010), and are widely interpreted as suggesting serotonergic neurotoxicity (Benningfield and Cowan, 2013; Parrott, 2013a; Puerta et al., 2009; Ricaurte et al., 2000). Recreational use of MDMA is also associated with various neuropsychobiological problems, including memory deficits (Montgomery et al., 2010; Rogers et al., 2009; Zakzanis and Campbell, 2006), impairments in higher cognitive processing (Fox et al, 2002; Parrott, 2012, 2013b; Reay et al., 2006), sleep apnea (McCann et al., 2009), raised cortisol levels (Parrott, 2009; Parrott et al., 2012), psychosocial impairment (Topp et al., 1999) and various psychiatric problems (Briere et al., 2012; MacInnes et al., 2000; Milani et al., 2004; Morgan et al., 2002; Schifano et al., 1998; Singer et al., 2004; Verheyden et al., 2003). "
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    ABSTRACT: Background: The recreational drug MDMA (3,4-methylenedioxymethamphetamine) or 'Ecstasy' is associated with heightened psychiatric distress and feelings of depression. The Drugs and Infancy Study (DAISY) monitored the psychiatric symptom profiles of mothers who used Ecstasy/MDMA while pregnant, and followed them over the first year post-partum. Methods: We compared 28 young women whom took MDMA during their pregnancy with a polydrug control group of 68 women who took other psychoactive drugs while pregnant. The Brief Symptom Inventory (BSI) was completed for several periods: The first trimester of pregnancy; and 1, 4 and 12 months after childbirth. Recreational drug use was monitored at each time point. Results: During the first trimester of pregnancy, MDMA-using mothers reported higher depression scores than the polydrug controls. At 1 year after childbirth, their BSI depression scores were significantly lower, now closer to the control group values. At the same time point, their self-reported use of MDMA became nearly zero, in contrast to their continued use of Cannabis/marijuana, nicotine and alcohol. We found significant symptom reductions in those with BSI obsessive-compulsive and interpersonal sensitivity, following Ecstasy/MDMA cessation. Conclusions: The findings from this unique prospective study of young recreational drug-using mothers are consistent with previous reports of improved psychiatric health after quitting MDMA.
    Full-text · Article · Dec 2013 · Journal of Psychopharmacology
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