Atomoxetine plus fesoterodine eases OSA severity in patients with milder collapsibility
11 Nov 2022
Use of atomoxetine and fesoterodine (Ato-Feso), administered for one night, helps manage obstructive sleep apnoea (OSA) in patients with milder upper airway collapsibility, although this treatment may not work in some individuals, a study has shown.
A team of investigators randomly assigned 12 patients with OSA to one night of Ato-Feso (80‒4 mg) or placebo. They calculated parameters of OSA severity (eg, apnoea‒hypopnoea index [AHI], nadir oxygen desaturation and hypoxic burden) from two clinical, in-lab polysomnographic studies. Validated algorithms were used to derive OSA endotypes (including collapsibility per VMIN and arousal threshold).
Ato-Feso did not reduce the AHI (34.2 vs 30.1 events/h; p=0.493), but it decreased the apnoea index (12.9 vs 1.8 events/h; p=0.027) and increased nadir desaturation (76.8 percent vs 82.2 percent; p=0.003) compared with placebo. Of note, a trend for improved hypoxic burden was seen, but this did not reach statistical significance (52.4 vs 29.7 %min/h; p=0.092).
Although Ato-Feso reduced collapsibility (raised VMIN; 43.7 [29.8–55.7] vs 56.8 [43.8–69.8] %VEUPNOEA; p=0.002), it also lowered the arousal threshold (129.3 vs 116.7 %VEUPNOEA; p=0.038).
The post hoc analysis revealed that all six patients with milder collapsibility (VMIN > 43 percent) had OSA resolution (drop in AHI >50 percent and residual AHI <10 events/h) and improved hypoxaemia.
“Ato-Feso may hold some promise as an alternative OSA treatment in certain subgroups of individuals,” the investigators said.
“The combination of the noradrenergic atomoxetine plus the antimuscarinic oxybutynin acutely increased genioglossus activity and reduced OSA severity. However, oxybutynin has shorter half-life than atomoxetine and side effects that might discourage long-term usage,” they noted.