Prescribed Medications Confound Oral Appliance Therapy in Obstructive Sleep Apnea
Objectives: The study purpose was to evaluate potentially confounding effects of antidepressants and hypnotic medications on obstructive sleep apnea (OSA) patients undergoing oral appliance (OA) therapy. This investigation is part of a larger randomized controlled trial (RCT) comparing two appliance designs and is intended to elucidate the interaction between OA therapy and previously prescribed medications.
Methods: The parent study was a cross-over RCT (4-weeks per OA with 1-week washout interval). Adults diagnosed with moderate or severe OSA using polysomnography (n=36; 18–70 years; apnea hypopnea indices ≥ 15 events/hour) who had rejected CPAP therapy were enrolled. Subjects were divided into two groups: (RxU) using ≥ one of the following drugs: selective serotonin reuptake inhibitor [SSRI], serotonin-norepinephrine reuptake inhibitor [SNRI] or non-benzodiazepine hypnotic and (NU) those not taking these medications. The effects of the 3 drug categories were also evaluated separately. At the end of each 4-week interval (T2 and T4) of OA treatment, the two groups were compared with each other and with baseline-pretreatment values. Primary outcome-variables were respiratory event index (REI), mean and minimum oxygen saturation derived from home sleep tests (NOX-T3, Vyaire Medical) and pulse oximetry (Nonin finger-probe).
Results: Mann-Whitney tests showed significantly lower mean O2 values(p ≤ 0.011) in Group-RxU versus Group-NU at T2 and T4, but not at baseline. Hypnotic-users had significantly lower O2 values vs those of NU at T2 and T4(p≤ 0.016). SNRI-users versus NU followed a similar trend (p ≤ 0.058). Minimum O2 values and REI values were not significantly different from baseline in either group.
Conclusions: Antidepressant SNRIs and hypnotics lower mean oxygen saturation levels in subjects using OA therapy. Clinicians managing OSA patients with OA therapy on these medications should be aware of this finding when evaluating OA treatment efficacy by oximetry values.