Reboxetine Prescribed Alone Reduces Sleep Apnea Severity

Reboxetine prescribed alone can reduce the severity of obstructive sleep apnea (OSA), according to new findings published in the Journal of Clinical Sleep Medicine.

“Recent research found a combination of the medicines reboxetine and oxybutynin, which were both previously used for unrelated conditions, could be an effective treatment for obstructive sleep apnea, but can cause side effects,” said lead author Thomas Altree, MBBS, FRACP, FHMRI: Sleep Health. “We wanted to see if reboxetine on its own could be effective and assess exactly how it changes breathing during sleep.”

The double-blind, placebo-controlled, randomized, multicenter crossover trial, conducted in collaboration with the Woolcock Institute in Sydney, involved 16 patients with OSA. The researchers studied single doses of reboxetine, combined doses of reboxetine and oxybutynin, and placebo.

News: Sleep Apnea Status Linked With White Matter Integrity, Cognition Over Time

Reboxetine along reduced the apnea-hypopnea index (AHI-primary outcome) by 5.4 events (P=0.03). The addition of oxybutynin did not produce any further reductions in AHI. Reboxetine alone reduced the 4% oxygen desaturation index by (mean ± SD) 5.2 ± 7.2 events/h, and reboxetine plus oxybutynin by 5.1 ± 10.6 events/h versus placebo, P=0.02. Nadir oxygen saturation also increased by 7 ± 11% with reboxetine, and 5 ± 9% with reboxetine plus oxybutynin versus placebo, P=0.01. 

“These findings,” Altree and coauthors concluded, “show the first evidence that reboxetine along reduces OSA severity.”

The study results also provide a fresh look at the role of norepinephrine reuptake inhibitors on “upper airway stability during sleep and are important to inform future pharmacotherapy development for OSA.”

Further, the results provide expanded options for patients seeking treatment for OSA who cannot tolerate current therapies, including continuous positive airway pressure (CPAP) machines.

"The current gold-standard treatment of sleep apnea is with a CPAP device during sleep. But this one-size-fits-all approach doesn't address the fact that there are different causes for sleep apnea. In addition, many people can't tolerate CPAP in the long term," Dr Altree told Medical Xpress.

References

Flinders University. Team finds a promising medication for sleep apnea. Press release. Medical Xpress. Published online October 6, 2022. Accessed October 25, 2022.

Altree TJ, Aishah A, Loffler KA, et al. The norepinephrine reuptake inhibitor reboxetine alone reduced obstructive sleep apnea severity: A double blind, placebo controlled, randomized, cross-over trial. J Clin Sleep Med. Published online August 25, 2022.  DOI: 10.5664/jcsm.10256