Role of protriptyline and acetazolamide in the sleep apnea/hypopnea syndrome

• Published in: Sleep (New York, N.Y.) N.Y.), 1988-10, Vol.11 (5), p.463-472
• Main Authors: Whyte, K F, Gould, G A, Airlie, M A, Shapiro, C M, Douglas, N J
• Format: Article
• Language: English
• Subjects: Acetazolamide - adverse effects; Acetazolamide - therapeutic use; Adult; Aged; Clinical Trials as Topic; Dibenzocycloheptenes - therapeutic use; Double-Blind Method; Female; Humans; Male; Middle Aged; Monitoring, Physiologic; Protriptyline - adverse effects; Protriptyline - therapeutic use; Sleep Apnea Syndromes - drug therapy
• ISSN: 0161-8105; 1550-9109
• DOI: 10.1093/sleep/11.5.463

The role of drug therapy in the treatment of the sleep apnea/hypopnea syndrome is unclear. In a randomised, double-blind, placebo-controlled study, we investigated the value of 14-day therapy with protriptyline (20 mg daily) or acetazolamide (250 mg 4 times per day) on symptoms and on the frequency of apneas, hypopneas, arousals, and 4% desaturations in 10 patients with obstructive sleep apnea/hypopnea syndrome. Overall, protriptyline did not have a significant effect either on symptoms or on any of the above polysomnographic criteria. Acetazolamide reduced the apnea/hypopnea frequency [placebo 50 +/- 26 (SD); acetazolamide 26 +/- 20/h of sleep, p less than 0.03] and tended to decrease the frequency of 4% desaturations (placebo 29 +/- 20; acetazolamide 19 +/- 16/h of sleep, p = 0.06). Despite these physiological improvements, acetazolamide did not significantly improve symptoms and paraesthesiae were common. Contrary to earlier studies, we conclude that protriptyline may have a limited role in the treatment of the sleep apnea syndrome. The reason why acetazolamide produced a physiological, but not a symptomatic, response requires further investigation.