Combined noradrenergic plus antimuscarinic agents for obstructive sleep apnea - A systematic review and meta-analysis of randomized controlled trials

Zha, Shiqian; Yang, Hongjiang; Fang, Yue; Hu, Ke

doi:10.1016/j.smrv.2022.101649

Cited by 10 publications

(7 citation statements)

References 38 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…3 According to a recent report regarding ATO-OXY therapy, improvements of AHI were probably driven by an increase in the responsiveness of the upper airway dilator muscles. 10,11 The conceivable reasons for the inconsistency of our results with that of the previous study performed in the United States are (1) ethnic or phenotypic trait differences in OSA pathogenesis and (2) differences in ATO-OXY reactivity in Japanese patients. The most recent report regarding ATO-OXY therapy for patients with OSA revealed that the concomitant use of zolpidem, which improves the arousal threshold, enhanced sleep efficiency.…”

Section: Discussioncontrasting

confidence: 90%

“…OXY has been reported to potentially prevent the muscle contraction effect of acetylcholine on upper airway muscle tone 3 . According to a recent report regarding ATO–OXY therapy, improvements of AHI were probably driven by an increase in the responsiveness of the upper airway dilator muscles 10,11 . The conceivable reasons for the inconsistency of our results with that of the previous study performed in the United States are (1) ethnic or phenotypic trait differences in OSA pathogenesis and (2) differences in ATO–OXY reactivity in Japanese patients.…”

Section: Discussioncontrasting

confidence: 71%

“…ATO potentially alleviates the narrowing of the upper airway by stimulating the upper airway motoneurons in the brainstem and worsening the arousal threshold. 10,11 OXY is an antimuscarinic agent with a high affinity for all muscarinic receptors, originally used to treat overactive bladders. OXY has been reported to potentially prevent the muscle contraction effect of acetylcholine on upper airway muscle tone.…”

Section: Discussionmentioning

confidence: 99%

“…Patients with low TST are considered to belong to the population having low sleep efficiency, which is associated with a lower arousal threshold. According to previous reports, 10,11 ATO reduces the arousal threshold, thereby causing the patients to require a lower ventilatory drive to trigger arousal from sleep and reducing the oversensitive ventilatory control system (loop gain). Noradrenergic agents, such as ATO, promote the central augmentation of motoneurons controlling the upper airway dilator muscles.…”

Section: Discussionmentioning

confidence: 99%

See 3 more Smart Citations

Effects of the combination of atomoxetine and oxybutynin in Japanese patients with obstructive sleep apnoea: A randomized controlled crossover trial

et al. 2022

View full text Add to dashboard Cite

Background and Objective: The possibility of combination therapy with atomoxetine (ATO) and oxybutynin (OXY) has been suggested for obstructive sleep apnoea (OSA). However, the effectiveness of this treatment remains uninvestigated in Japanese OSA patients. Therefore, we performed a randomized, crossover, phase II, single-centre prospective trial to examine the effects of ATO-OXY therapy in Japanese OSA patients. Methods: In total, 17 OSA patients participated in this study. The effects of one night of 80-mg ATO plus 5-mg OXY administration were compared with those of no medication administered before sleep. The primary and secondary outcomes comprised the apnoea-hypopnoea index (AHI) and nadir SpO 2 , SpO 2 drop time and sleep architecture, respectively. The safety endpoints included drug side effects and adverse events. Results: The values of AHI, nadir SpO 2 , 3% oxygen desaturation index (ODI), 4% ODI, and SpO 2 drop time of <90% did not significantly differ between patients receiving ATO-OXY administration and no medication. Sleep architecture exhibited a significant change: ATO-OXY increased sleep stage N1 (p < 0.0001) and decreased stage N2 (p = 0.03), rapid eye movement (p < 0.0001) and sleep efficiency (p = 0.02). However, the subanalysis demonstrated an obvious decrease in AHI in five responder patients. Total sleep time and basal sleep efficiency tended to be lower in the responders compared with nonresponders (p = 0.065). No patients experienced severe adverse events or side effects. Conclusion: Overall, ATO-OXY therapy does not reduce AHI in Japanese OSA patients, although AHI was decreased in a proportion of patients. Future studies for identifying treatment response group characteristics are warranted.

show abstract

Section: Discussioncontrasting

confidence: 90%

Section: Discussioncontrasting

confidence: 71%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 2 more Smart Citations

Effects of the combination of atomoxetine and oxybutynin in Japanese patients with obstructive sleep apnoea: A randomized controlled crossover trial

et al. 2022

View full text Add to dashboard Cite

show abstract

“…Afterwards, Dr. Elisa Perger presented two randomized controlled trials 32,33 that showed a significant reduction of AHI and hypoxic burden in OSA patients treated with a noradrenergic and antimuscarinic combination versus placebo. However, a recent meta-analysis 34 on the topic showed that further evidence on long-term safety and efficacy of this pharmacological combination in OSA patients is required.…”

Section: Sleep Disordered Breathing: New Pharmacological Perspectivesmentioning

confidence: 99%

ERS International Congress 2022: highlights from the Sleep Disordered Breathing Assembly

Bradicich

Siciliano²,

Schiavi

et al. 2023

ERJ Open Res

View full text Add to dashboard Cite

During the European Respiratory Society International Congress 2022 in Barcelona (Spain), the latest research and clinical topics in respiratory medicine have been presented. The sleep medicine-focused presentations and symposia provided novel insights into the pathophysiology of sleep-disordered breathing, its diagnostics and new trends in translational research and clinical applications. The presented research trends focused mainly on the assessment of sleep disordered breathing-related intermittent hypoxia, inflammation, and sleep fragmentation and their implications, especially cardiovascular. The most promising methods for assessing these aspects encompass genomics, proteomics and cluster analysis. The currently available options include positive airway pressure and a combination of it and pharmacological agents (e.g.sulthiame). This article summarises the most relevant studies and topics to this extent presented at the ERS International Congress 2022. Each section has been written by Early Career Members of the ERS Assembly 4.

show abstract

Combination of acute intermittent hypoxia and intermittent transcutaneous electrical stimulation in obstructive sleep apnea: a randomized controlled crossover trial

Zha,

Liu,

Chen

et al. 2024

Respiratory Physiology & Neurobiology

View full text Add to dashboard Cite

Combined noradrenergic plus antimuscarinic agents for obstructive sleep apnea - A systematic review and meta-analysis of randomized controlled trials

Cited by 10 publications

References 38 publications

Effects of the combination of atomoxetine and oxybutynin in Japanese patients with obstructive sleep apnoea: A randomized controlled crossover trial

Effects of the combination of atomoxetine and oxybutynin in Japanese patients with obstructive sleep apnoea: A randomized controlled crossover trial

ERS International Congress 2022: highlights from the Sleep Disordered Breathing Assembly

Combination of acute intermittent hypoxia and intermittent transcutaneous electrical stimulation in obstructive sleep apnea: a randomized controlled crossover trial

Contact Info

Product

Resources

About