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Trial registered on ANZCTR
Registration number
ACTRN12610001074088
Ethics application status
Approved
Date submitted
23/11/2010
Date registered
6/12/2010
Date last updated
11/04/2011
Type of registration
Retrospectively registered
Titles & IDs
Public title
Can minocycline reverse morphine-induced respiratory depression in obstructive sleep apnea patients?- A pilot study
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Scientific title
Obstructive sleep apnea patients administrated minocycline may reverse morphine-induced respiratory depression without reducing the analgesic effects
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Secondary ID [1]
253151
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Protocol number X10-0268, Ethics Review Committee (RPAH Zone) of the Sydney South West Area Health Service.
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Universal Trial Number (UTN)
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Trial acronym
The ROD study (Reverse Opioid-respiratory-Depression)
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Linked study record
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Health condition
Health condition(s) or problem(s) studied:
obstructive sleep apnea
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Condition category
Condition code
Respiratory
258853
258853
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0
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Sleep apnoea
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Intervention/exposure
Study type
Interventional
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Description of intervention(s) / exposure
This is a double-blind, placebo-controlled, cross-over study. All subjects will undergo 2 overnight sleep studies separated by an interval of at least 1 week. The Sleep Study measures the effects of the drug on breathing and oxygen levels during sleep.
After signed and informed consent is given, participants would be prescribed a 3 day course of either active or placebo oral minocycline, depending on their randomisation. Patients will be asked to take a single loading dose of 200 mg of minocycline/placebo at around 8pm two days before the first sleep study. For the next two days patients take 100 mg minocyclin/placebo twice a day (8am and 8pm approximately), including the sleep testing day.
First PSG study: Patient finishes dinner at 5pm, and takes a single dose of 30mg MS Contin (oral slow release morphine)at 5:30pm. At 8pm, the patient takes scheduled 100mg minocycline/placebo. At 9pm, patient will be tested for pain threshold (Von Frey hair test), and a short 10 minute clinical test of breathing, the central ventilatory chemosensitivity test. An indwelling venous catheter will be inserted and 5ml of venous blood will be taken for drug concentration/metabolites analysis. At 10pm, PSG sleep study starts. After awakening the next morning the patient will be discharged with the 3 days dose of cross-over minocycline/placebo to be taken at home before the next scheduled sleep study.
The second arm of the study, the procedure is identical to the first arm except the patient has been provided the opposite treatment according to the randomization schedule.
Second PSG study: The procedure is identical to the first PSG night, except that the subject takes 100mg cross-over minocycline/placebo at 8pm (the second dose of the day).
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Intervention code [1]
257656
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Prevention
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Intervention code [2]
257710
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Treatment: Drugs
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Comparator / control treatment
Oral slow release morphine plus either active or placebo oral minocycline. Placebos are lactose filled capsules. More details can be found in "Descrptions of interventions".
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Control group
Placebo
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Outcomes
Primary outcome [1]
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SpO2 (Oxygen Saturation) nadir during sleep
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Assessment method [1]
259705
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Timepoint [1]
259705
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at two cross-over polysomnography (PSG) nights and at screening (baseline) PSG night
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Primary outcome [2]
259706
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%Total sleep time SpO2 <90% during sleep. The parameter is part of the PSG measurement.
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Assessment method [2]
259706
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Timepoint [2]
259706
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at two cross-over PSG nights and at screening (baseline) PSG night
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Primary outcome [3]
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Central chemosensitivity tested by ventilatory chemoreflex tesing system
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Assessment method [3]
259707
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Timepoint [3]
259707
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at two cross-over PSG evenings during awake and at screening (baseline) examination
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Secondary outcome [1]
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Oxygen desaturation index (ODI) as part of PSG assessment
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Assessment method [1]
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Timepoint [1]
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at two cross-over PSG nights and at screening (baseline) PSG night
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Secondary outcome [2]
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CO2 recruitment threshold tested by chemoreflex testing system
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Assessment method [2]
266424
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Timepoint [2]
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at two cross-over PSG evenings during awake and at screening (baseline) examination
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Secondary outcome [3]
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Pain threshold (Mechanical Detection Threshold) tested by Von Frey Hair
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Assessment method [3]
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Timepoint [3]
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at two cross-over PSG evenings during awake
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Eligibility
Key inclusion criteria
Aged between 18-60 years who have previously been tested by a polysomnography (PSG) study that shows they have sleep apnoea, with Apnea Hypopnea Index >15/hr and SpO2 nadir 90-70%.
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Minimum age
18
Years
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Maximum age
60
Years
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Sex
Males
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Can healthy volunteers participate?
No
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Key exclusion criteria
1. History of adverse effects from opioids or minocycline. 2. History of drug abuse. 3. Regular use of opiates. 4. Current or recent severe physiological or psychological illness including severe cardiovascular (hypertension) or CNS diseases. 5. Presence of another severe sleep disorders (such as period limb movement disorders or shift work sleep disorder). 6. Concurrent using CPAP or taking of other medications which might interfere with the study drugs.
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Study design
Purpose of the study
Prevention
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Allocation to intervention
Randomised controlled trial
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Procedure for enrolling a subject and allocating the treatment (allocation concealment procedures)
All sleep apnea patients will undergo a medical examination by a physician. A detailed medical history will be obtained with particular reference to history of drug allergy, respiratory illness, past and current substance abuse, sleep patterns and snoring. Patients will be fully informed of the details of the project and invited to sign the consent form if they are willing and able to participate in the study. Allocation of either active or placebo minocycline is administrated by a research pharmacist at RPA Hospital Pharmacy who is not an investigator of the study.
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Methods used to generate the sequence in which subjects will be randomised (sequence generation)
The order of the active or placebo minocycline was decided using simple procedure of coin-tossing
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Masking / blinding
Blinded (masking used)
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Who is / are masked / blinded?
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Intervention assignment
Crossover
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Other design features
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Phase
Phase 1 / Phase 2
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Type of endpoint/s
Safety/efficacy
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Statistical methods / analysis
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Recruitment
Recruitment status
Recruiting
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Date of first participant enrolment
Anticipated
23/11/2010
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Actual
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Date of last participant enrolment
Anticipated
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Actual
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Date of last data collection
Anticipated
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Actual
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Sample size
Target
10
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Accrual to date
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Final
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Recruitment in Australia
Recruitment state(s)
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Funding & Sponsors
Funding source category [1]
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University
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Name [1]
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Sydney Medical School New Staff Awards
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Address [1]
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Woolcock Institute of Medical Research
431 Glebe Point Rd, Glebe. NSW 2037
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Country [1]
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Australia
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Primary sponsor type
Government body
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Name
NHMRC Training Fellowship
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Address
Woolcock Institute of Medical Research
431 Glebe Point Rd, Glebe. NSW 2037
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Country
Australia
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Secondary sponsor category [1]
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Hospital
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Name [1]
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RPAH
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Address [1]
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Missenden Rd, Camperdown 2050 NSW
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Country [1]
257300
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Australia
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Other collaborator category [1]
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University
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Name [1]
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University of Adelaide
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Address [1]
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Discipline of Pharmacology
Faculty of Health Sciences
The University of Adelaide
Adelaide 5005 SA
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Country [1]
251674
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Australia
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Other collaborator category [2]
251717
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Other Collaborative groups
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Name [2]
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Pain Management Research Institute
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Address [2]
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Royal North Shore Hospital, St Leonards NSW 2065
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Country [2]
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Australia
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Ethics approval
Ethics application status
Approved
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Ethics committee name [1]
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Ethics Review Committee (RPAH Zone) of the Sydney South West Area Health Service
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Ethics committee address [1]
260105
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Research Development Office Level 3, Building 92 Royal Prince Alfred Hospital Missenden Road CAMPERDOWN NSW 2050
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Ethics committee country [1]
260105
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Australia
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Date submitted for ethics approval [1]
260105
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12/09/2010
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Approval date [1]
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28/10/2010
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Ethics approval number [1]
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X10-0268
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Summary
Brief summary
Opioids are commonly used for a number of clinical settings, including treatment of acute pain, trauma, cancer, non-malignant chronic pain and in methadone maintenance treatment programs. In Australia, the number of PBS opioid prescriptions increased three-fold, from 2.4 million in 1992 to 7.0 million in 2007. Due to the rapid increase in opioid prescriptions, unintentional drug poisoning mortality rates have also increased substantially, with deaths attributed primarily to prescription opioid analgesics. A US study reported that more than 90% of unintentional medication poisoning deaths were caused by opioid analgesics. In Australia, the National Hospital Morbidity Database showed a three-fold increase in the number of separations from hospitals as a result of unintentional poisoning by opioids other than heroin or methadone from 1998/99 to 2006/07. Death from opioids is nearly always due to respiratory arrest.5,6 Acute opioid use can reduce vital ventilatory chemoreflexes and cause severe hypoventilation. The immediate cause of death is often pulmonary oedema secondary to prolonged hypoventilation. The sleep state is the most vulnerable time for patients using opioids. During sleep, respiration is naturally depressed and mainly under automatic neural-chemical control. Acute opioid use significantly reduces vital chemoreflexes, and patients have an increased risk of respiratory arrest during sleep. In addition, recent studies found that acute opioid use reduces upper airway patency during sleep. It is therefore not surprising that OSA is reported to be a major risk factor for postoperative morbidity and mortality. There are only two clinically available classes of drugs that can potentially reduce the respiratory depressant effect of opioids without reducing the analgesic effects. One is 5HT4a receptor agonists. Animal studies indicate that this drug class can reverse opioid-related respiratory depression without affecting sedation. However, the only clinical study found that it did not antagonize morphine-induced respiratory depression. In addition, the drug class was reported to cause the long QT syndrome and has been not registrated for clinical use in many countries, such as USA. In contrast, the tetracycline antibiotic Minocycline, a microglial inhibitor, is a commonly used antibiotic for many years particularly for acne. It is known to reduce opioid-induced glial activation which could enhance the analgesic effect of opioids and reduce the development of opioid tolerance. Dr Hutchinson from Prof Somogyi (AIB)’s laboratory found that in rats, Minocycline reversed morphine-induced respiratory depression while enhancing morphine-induced analgesia. However, the effect has not been tested in humans. If the findings can be verified in humans, the study may be a pivotal study in reducing the striking number of opioids-related deaths. The proposed double-blinded, cross-over study is a pilot study which may lead to a major NHMRC project grant application.
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Trial website
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Trial related presentations / publications
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Public notes
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Contacts
Principal investigator
Name
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Address
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Country
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Phone
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Fax
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Email
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Contact person for public queries
Name
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Dr David Wang
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Address
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Woolcock Institute of Medical Research
431 Glebe Point Rd, Glebe, 2037, NSW
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Country
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Australia
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Phone
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+61 2 9114 0446
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Fax
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+61 2 9114 0014
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Email
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[email protected]
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Contact person for scientific queries
Name
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Dr David Wang
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Address
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Woolcock Institute of Medical Research
431 Glebe Point Rd, Glebe, 2037, NSW
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Country
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Australia
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Phone
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+61 2 9114 0446
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Fax
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+61 2 9114 0014
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Email
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[email protected]
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No information has been provided regarding IPD availability
What supporting documents are/will be available?
No Supporting Document Provided
Current supporting documents:
Updated to:
Doc. No.
Type
Citation
Link
Email
Other Details
Attachment
New Record*
Clinical study report
Wang D†, Somogyi AA, Yee BJ, Wong KK, Kaur J, Wrigley PJ, Grunstein RR. The effects of a single mild dose of morphine on chemoreflexes and breathing in obstructive sleep apnea. Resp Physio Neuro 2013; 185:526-532.
336268-(Uploaded-12-08-2024-09-24-28)-David-Resp-Physio-Neuro-2013.pdf
Results publications and other study-related documents
Documents added manually
No documents have been uploaded by study researchers.
Documents added automatically
No additional documents have been identified.
Download to PDF