Efficacy of Antidepressants in the Treatment of Obstructive Sleep Apnea Compared to Placebo. A Systematic Review with Me
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SLEEP BREATHING PHYSIOLOGY AND DISORDERS • REVIEW
Efficacy of Antidepressants in the Treatment of Obstructive Sleep Apnea Compared to Placebo. A Systematic Review with Meta-Analyses. Magda R. AbdelFattah 1,2
&
Song W. Jung 1
&
Melvin A. Greenspan 1
&
Mariela Padilla 3
&
Reyes Enciso 4
Received: 10 June 2019 / Revised: 19 September 2019 / Accepted: 29 September 2019 # Springer Nature Switzerland AG 2019
Abstract Purpose To establish the efficacy of oral antidepressants compared to placebo in improving obstructive sleep apnea (OSA) as measured on a polysomnography study. Secondary outcomes included self-reported sleepiness. Methods Authors identified prospective randomized placebo-controlled studies from MEDLINE through PubMed, Web of Science, the Cochrane Library and EMBASE up to February 2019 in English language. Antidepressants included tricyclic antidepressants (TCA), tetracyclic antidepressants (TeCA), selective serotonin reuptake inhibitors (SSRI), and serotonin receptor modulators (SRM). Studies were assessed for inclusion and exclusion criteria, as well as risk of bias based on the Cochrane handbook. Results The initial search yielded 254 unduplicated references ultimately reduced to 8 relevant studies, in which 198 OSA participants were included. Patients with an average baseline AHI of 26.7 events/hour taking 15-45mg mirtazapine had a statistically significant reduction in apnea-hypopnea index compared to placebo by -10.5 events/hour (p 10 events/h during supine NREM sleep 23] 2 No known allergies to medications 1. daytime sleepiness 2. apnea index ≥ 10
1 OSA diagnosed in a previous overnight study (oxygen desaturation index based on self-reported sleep duration ≥10 hours) 2 aged 25-65 years 1 at least 21 years old, 2 AHI of 10 to 40 3 body mass index (BMI) of 40 kg/m2 or less (Study 1) or had a BMI of 34 kg/m2 of less (Study 2) 4 either had never used CPAP or had used it for less than 4 days within the past year 5 Nonsmokers or had no history of smoking for at least 2 years, 6 Baseline Epworth Sleepiness Scale score higher than 10.
1 OSA confirmed by PSG 2 Naïve to any form of treatment 3 Diagnosis of sleep apnea syndrome [22]
2 Obese men 3 OSA confirmed by PSG
1 severe sleep apnea AHI>60
Inclusion criteria
1. AHI>15 events/hour [26] 2. aged 18–65 years
8M/0F 44.9 ± 7.8 [31 to 54] years
Apnea index ≥ 10
AHI > 10
Baseline AHI Study 1: 24.1 ±8.0 --Study 2: 27.4 ±11.1
AHI not reported
Baseline AHI Men: 22.0±11.2 Female: 24.1±22.8
AHI not reported
AHI>60
Baseline AHI mean±SD
10M/4F UNCLEAR 55 average [18 to 65] years
UNCLEAR
UNCLEAR
HIGH
Study 1: 15M/3F mean: 47 [28 to 64] years Study 2: 56M/9F mean: 52 [30 to 74 ]years
7M/6F 52 ± 3 [26 to 69] years
HIGH
HIGH
HIGH
Unclear
Summary of Risk of Bias
20M/0F 52.1 ± 8.7 [25 to 65]
7M/5F 18-67 years Men: 39.0 ± 18.3 Female: 43.4 ± 14.2
5M/0F 45.8 ±5.3
8M/0F 48.0±1.9 years
Gender and age (average±SD) [range] years
Abbreviations: DBRC: Double-blind randomized crossover; N: sample size; M: Male; F: Female; AASM: American Academy
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