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Published online before print December 2, 2009, doi:10.1212/WNL.0b013e3181c51a62)
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NEUROLOGY 2009;73:2011-2017
© 2009 American Academy of Neurology

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

Una D. McCann, MD, Francis P. Sgambati, BSE, Alan R. Schwartz, MD and George A. Ricaurte, MD, PhD

From the Department of Psychiatry (U.D.M., F.P.S.), Department of Medicine, Division of Pulmonary and Critical Care (A.R.S.), and Department of Neurology (G.A.R.), The Johns Hopkins School of Medicine, Baltimore, MD.

Address correspondence and reprint requests to Dr. Una D. McCann, Department of Psychiatry, The Johns Hopkins School of Medicine, 5501 Hopkins Bayview Circle, Room 5B71c, Baltimore, MD 21224 umccann{at}jhmi.edu

Background: 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.

Methods: 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.

Results: 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.

Conclusions: 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.

Abbreviations: AHI = apnea hypopnea index; BMI = body mass index; DSM-IV = Diagnostic and Statistical Manual of Mental Disorders, 4th edition; MDMA = methylenedioxymethamphetamine; NREM = non-REM; OR = odds ratio; OSA = obstructive sleep apnea; PSG = polysomnography; SCID-I = Scheduled Diagnostic Interview for DSM-IV; SDB = sleep-disordered breathing.

Editorial, page 1947

Supplemental data at www.neurology.org

e-Pub ahead of print on December 2, 2009, at www.neurology.org.

Supported by Public Health Service grants DA16563 (McCann), DA05938 and DA01796401 (Ricaurte), and NCRR grant M01RR002719 (Ford).

Disclosure: Author disclosures are provided at the end of the article.

Received March 12, 2009. Accepted in final form August 12, 2009.


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