Spironolacton restore sleep architecture case report

Observation :
Since more 15 years Mrs N. VER was followed for a primary sleep hypersomnia. Her first complaint in 2003 is daytime somnolence (Epworth Score of 20)
Clinical investigations with PSG and MSLT were performed in 2003, 2004, 2010, 2014 and 02-2018. Mean latency was higher than 8min in 2003, 2004 and 2018 but lower in 2010, 2014. HLA phenotype is DR11/DR13 DQ03/03. PSG show on all polysomnography a sleep fragmentation (30 arousal), a reduction of rem sleep duration (8-10% of TST). All ECG signal show an ST elevation.
Mrs VER present comorbidity (Hypertension, Bipolar disease). Cardiologist introduce at the begining of 2018 Spironolacton
A polysomnography was performed in 09-2018. Very surprisingly, there is an improvement in sleep architecture with a significant reduction in the number of arousal (7 / h) and an increase in the duration of REM sleep (21% of TST).
Discussion :
Animal studies report than mineralocorticoid receptor blockers (MRB) restore 24-h blood pressure circadian rhythm (1), human studies show MRB improve bloop pressure circadian rythm (2) it was also reported in other pathologies like fibromyalgia than MBR improve sleep efficiency, sleep endocrine studies (4) show a reduction of nocturnal plasma GH maxmimum after sleep onset. Improvment of chronobiological rythms appear to be an effect of MRB. It is necessary to complete this case report with further studies.
Bibliography :
(1) Yan Zhang & al, Eplerenone restores 24-h blood pressure circadian rhythm and reduces advanced glycation end- products in rhesus macaques with spontaneous hypertensive metabolic syndrome - DOI : 10.1038/srep23957Yan Zhang1,3,
(2) Yang & al, Effect of spironolactone on patients with resistant hypertension and obstructive sleep apnea - CLINICAL AND EXPERIMENTAL HYPERTENSION 2016, VOL. 38, NO. 5, 464–468 http://dx.doi.org/10.3109/10641963.2015.1131290
(3) Heinrich Wernze & al, Long-term efficacy of spironolactone on pain, mood, and quality of life in women with fibromyalgia : An observational case series - DOI : https://doi.org/10.1016/j.sjpain.2013.12.003
(4) Axel Steiger & al, Functional properties of Deoxycorticosterone and spironolactone : Molecular characterization
and effects on sleep-endocrine activity, J. Psychiatr Research,Vol 27, N°3 pp 275 284, 1993