Dados do Trabalho

Título

Efficacy of the Association of Atomoxetine and Oxybutynin in the Treatment of Obstructive Sleep Apnea: A Systematic Review

Introdução

Obstructive Sleep Apnea(OSA) is a prevalent sleep disorder characterized by repeated upper airway obstruction during sleep, leading to sleep fragmentation, hypoxemia, and hypercapnia. Effective pharmacological treatments are limited, and the standard treatment, CPAP therapy, is often poorly tolerated. Recent studies have explored combining atomoxetine, a noradrenaline reuptake inhibitor, with oxybutynin, an antimuscarinic agent, in treating OSA. This combination takes advantage of the noradrenergic and antimuscarinic properties of the drugs to increase upper airway muscle activity and improve airway patency during sleep.

Objetivo

This study aims to evaluate the efficacy of combining atomoxetine and oxybutynin in treating OSA.

Métodos

The PRISMA protocol was followed to guide the preparation of this systematic review. The databases used were PubMed, Embase, Cochrane, and Web of Science. The inclusion criteria involved studies investigating the association between atomoxetine and oxybutynin to assess clinical outcomes in OSA patients.

Resultados

A total of 270 articles were selected, of which 10 met the inclusion criteria. Schweitzer et al. evaluated 60 patients in a randomized clinical trial(RCT) and observed an improvement in the Apnea and Hypopnea Index (AHI) in patients treated with the combination of atomoxetine and oxybutynin (ato-oxy) compared to the placebo group[6.2 events/h (2.8-13.6) vs 14.2 events/h (5.4-22.3), p < 0.001]. In addition, the group receiving atomoxetine alone showed a significant reduction in obstructive events during sleep, with 4.8 events/h (1.4-11.6, p < 0.001). An RCT by Taranto-Montemurro et al. examined 20 people with OSA, 10 of whom were in the ato-oxy group and 10 in the placebo group. A statistically significant improvement was found in AHI [28.5 (10.9-51.6) vs 7.5 (2.4-18.6), p < 0.001] and an increase in sleep efficiency, although not statistically significant[71 (63-84) vs 67 (45-86), p = 0.16], compared to the placebo group. In an RCT with 39 participants with OSA, Aishah et al. investigated the variation in AHI on the 30th day of treatment. The ato-oxy group showed a more marked reduction in AHI compared to placebo (-8±16 vs 1±5 events/h; p = 0.09).

Conclusões

This systematic review analyzed the combination of atomoxetine and oxybutynin as a treatment option for OSA, showing a positive outcome in reducing AHI. However, more studies are needed to determine which patient profiles benefit most from this intervention.

Palavras -chave

Obstructive sleep apnea; Atomoxetine; Oxybutynin