Primary Outcome Measures:
- Mean oxygen saturation during sleep for the entire night measured by pulse oximetry. [ Time Frame: Crossover Period 1 Night 1 and Crossover Period 2 Night 1 ] [ Designated as safety issue: Yes ]
Secondary Outcome Measures:
- Mean oxygen saturation calculated for each hour of the night, as measured by pulse oximetry. [ Time Frame: Crossover Period 1 Night 1 and Crossover Period 2 Night 1 ] [ Designated as safety issue: Yes ]
- Mean oxygen saturation for rapid eye movement sleep stages, as measured by pulse oximetry. [ Time Frame: Crossover Period 1 Night 1 and Crossover Period 2 Night 1 ] [ Designated as safety issue: Yes ]
- Mean oxygen saturation for non- rapid eye movement sleep stages, as measured by pulse oximetry. [ Time Frame: Crossover Period 1 Night 1 and Crossover Period 2 Night 1 ] [ Designated as safety issue: Yes ]
- Minutes for which oxygen saturation was less than 80% as measured by pulse oximetry. [ Time Frame: Crossover Period 1 Night 1 and Crossover Period 2 Night 1 ] [ Designated as safety issue: Yes ]
- Minutes for which oxygen saturation was less than 90% as measured by pulse oximetry. [ Time Frame: Crossover Period 1 Night 1 and Crossover Period 2 Night 1 ] [ Designated as safety issue: Yes ]
- Apnea-hypopnea index as determined by polysomnography. [ Time Frame: Crossover Period 1 Night 1 and Crossover Period 2 Night 1 ] [ Designated as safety issue: Yes ]
- Latency to persistent sleep as determined by polysomnography. [ Time Frame: Crossover Period 1 Night 1 and Crossover Period 2 Night 1 ] [ Designated as safety issue: Yes ]
- Total sleep time as determined by polysomnography. [ Time Frame: Crossover Period 1 Night 1 and Crossover Period 2 Night 1 ] [ Designated as safety issue: Yes ]
- Sleep efficiency as determined by polysomnography. [ Time Frame: Crossover Period 1 Night 1 and Crossover Period 2 Night 1 ] [ Designated as safety issue: Yes ]
- Wake time after persistent sleep onset as determined by polysomnography. [ Time Frame: Crossover Period 1 Night 1 and Crossover Period 2 Night 1 ] [ Designated as safety issue: Yes ]
- Number of awakenings after persistent sleep as determined by polysomnography. [ Time Frame: Crossover Period 1 Night 1 and Crossover Period 2 Night 1 ] [ Designated as safety issue: Yes ]
- Percentage of time in rapid eye movement sleep as determined by polysomnography. [ Time Frame: Crossover Period 1 Night 1 and Crossover Period 2 Night 1 ] [ Designated as safety issue: Yes ]
- Percentage of time in stage 1 sleep as determined by polysomnography. [ Time Frame: Crossover Period 1 Night 1 and Crossover Period 2 Night 1 ] [ Designated as safety issue: Yes ]
- Percentage of time in stage 2 sleep as determined by polysomnography. [ Time Frame: Crossover Period 1 Night 1 and Crossover Period 2 Night 1 ] [ Designated as safety issue: Yes ]
- Percentage of time in stage 3/4 sleep as determined by polysomnography. [ Time Frame: Crossover Period 1 Night 1 and Crossover Period 2 Night 1 ] [ Designated as safety issue: Yes ]
- Latency to rapid eye movement sleep as determined by polysomnography. [ Time Frame: Crossover Period 1 Night 1 and Crossover Period 2 Night 1 ] [ Designated as safety issue: Yes ]
- Subjective sleep latency as determined by postsleep questionnaire. [ Time Frame: Crossover Period 1 Morning 1 and Crossover Period 2 Morning 1 ] [ Designated as safety issue: No ]
- Subjective total sleep time as determined by postsleep questionnaire. [ Time Frame: Crossover Period 1 Morning 1 and Crossover Period 2 Morning 1 ] [ Designated as safety issue: No ]
- Subjective Sleep Quality as determined by postsleep questionnaire. [ Time Frame: Crossover Period 1 Morning 1 and Crossover Period 2 Morning 1 ] [ Designated as safety issue: No ]
- Subjective number of awakenings as determined by postsleep questionnaire. [ Time Frame: Crossover Period 1 Morning 1 and Crossover Period 2 Morning 1 ] [ Designated as safety issue: No ]
About 30% of the adult population report sleep disturbance and 10% meet diagnostic criteria for chronic insomnia. While 20 -25% of these individuals have primary insomnia the vast majority have an additional condition such as chronic obstructive pulmonary disease. Several studies have looked at this and have estimated that 30% to 48% of the general population is affected at some time in their life with a form of insomnia that goes on for several months, and about one third of those are described as severely affected. Daytime symptoms of insomnia include tiredness, lack of energy, difficulty concentrating and irritability. Recent epidemiologic research focusing on the quality of life has identified significant insomnia related conditions or diseases that relate to work productivity, health care utilization, and risk of depression. Insomnia is associated with diminished work output, absenteeism and greater rates of accidents.
Ramelteon, is being developed as a sleep promoting agent based on agonism of melatonin receptor subtype 1 and 2. Ramelteon is marketed in the United States as Rozerem™ for the treatment of insomnia characterized by difficulty with sleep initiation.
Sleep problems are common in patients with chronic obstructive pulmonary disease. There is evidence that traditional hypnotics can cause adverse respiratory effects in insomniac populations with respiratory disorders, and so the safety and efficacy of new hypnotic agents must be ascertained in this group of patients.
This study will examine if ramelteon has respiratory depressant effects in subjects with moderate to severe chronic obstructive pulmonary disease. Study participation is anticipated to be about 6 weeks.