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Chapter 37 - Sodium oxybate for the treatment of excessive sleepiness

from Section 4 - Therapy of Excessive Sleepiness

Published online by Cambridge University Press:  04 February 2011

By
Neil T. Feldman
Edited by
Michael J. Thorpy  and
Michel Billiard
Michael J. Thorpy
Affiliation:
Sleep-Wake Disorders Center, Montefiore Medical Center, Bronx, NY, USA
Michel Billiard
Affiliation:
Guide Chauliac Hospital, Montpellier, France
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Summary

Sodium oxybate (SXB) can play a significant role in the treatment of excessive sleepiness associated with narcolepsy, although it does not normalize alertness in most patients. Evidence supporting the role of γ-hydroxybutyrate (GHB) as a neurotransmitter includes a synthesis pathway, vesicular storage, calcium-dependent release and subsequent re-uptake mechanisms. Current evidence suggests GHB may regulate dopaminergic transmission in nigrostriatal and mesocorticolimbic pathways. The effects of GHB at the GHB receptors are excitatory while those at the γ-aminobutyric acid (GABA)-B receptors are inhibitory. Endogenous GHB is synthesized via transamination of GABA to succinic semialdehyde which is then reduced to GHB. Patients taking SXB may display widely divergent therapeutic benefit, with some patients achieving a very robust therapeutic benefit while others receive no response. Future clinical trials should be conducted that will assess the effects of SXB for the treatment of excessive sleepiness associated with other disorders.

Keywords

behavioral responsivenessdopamine systemsexcessive daytime sleepinesssleep onset rapid-eye-movement sleepthalamocortical arousal stateParkinson's diseasenocturnal movementmultiple sleep latency test
Type
Chapter
Information
Sleepiness
Causes, Consequences and Treatment
 , pp. 421 - 429
Publisher: Cambridge University Press
Print publication year: 2011

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