In a recent randomized controlled trial, researchers evaluated if reboxetine, a selective norepinephrine reuptake inhibitor, could reduce the severity of obstructive sleep apnea (OSA) when used alone or in combination with an antimuscarinic—in this case oxybutynin.
The study’s lead author, Thomas Altree, FRACP, and colleagues reported that reboxetine alone reduced the severity of OSA, further adding to recent findings on the role of noradrenergic and muscarinic processes in pharyngeal muscle control during sleep. The team’s findings were presented in the Journal of Clinical Sleep Medicine.
Reboxetine Reduced Severity of Obstructive Sleep Apnea
This was a double-blinded, placebo-controlled, 3-way crossover study conducted at 2 centers. The study’s primary end point was apnea-hypopnea index, and groups received single administrations of 4 mg reboxetine, 4 mg reboxetine with 5 mg oxybutynin, or a placebo. The final analysis included 10 men and 6 women who completed 3 polysomnograms with approximately 1 week of washout.
According to the researchers, patients who received reboxetine had a reduction in apnea-hypopnea index of 5.4 events per hour (95% CI, -10.4 to -0.3; P=.03). Authors noted the reboxetine plus oxybutynin group had no further reduction in apnea-hypopnea index compared with the reboxetine monotherapy group, suggesting that the addition of the antimuscarinic did not further reduce values.
Authors reported reboxetine monotherapy and reboxetine plus oxybutynin reduced mean 4% oxygen desaturation index by 5.2 ± 7.2 and 5.1 ± 10.6 events per hour, respectively, compared with placebo (P =.02). Additionally, mean Nadir oxygen saturation increased by 7 ± 11% and 5 ± 9% with reboxetine and reboxetine plus oxybutynin, respectively, versus placebo (P = .01).
Overall, the authors summarized that their findings “provide novel insight into the role of norepinephrine reuptake inhibitors on upper airway stability during sleep and are important to inform future pharmacotherapy development for OSA.”