Are noradrenergics combined with antimuscarinics the future pharmacologic treatment for obstructive sleep apnea? A systematic review and meta-analysis of randomized controlled trials.

Autor: Bady Z; Faculty of Medicine, Assiut University, Assiut, Egypt., Mohammed HE; Faculty of Medicine, Assiut University, Assiut, Egypt., Aboeldahab H; Medical Research Group of Egypt (MRGE), Negida Academy, Cairo, Egypt.; Clinical Research Department, El-Gomhoria General Hospital, MOHP, Alexandria, Egypt.; Biomedical Informatics and Medical Statistics Department, Medical Research Institute, Alexandria University, Alexandria, Egypt., Samir M; Medical Research Group of Egypt (MRGE), Negida Academy, Cairo, Egypt.; Faculty of Medicine for Boys, Al-Azhar University, Cairo, Egypt.; Gastroenterology & Liver Diseases, Case Western Reserve University School of Medicine, Cleveland, OH, USA., Aissani MS; Medical Research Group of Egypt (MRGE), Negida Academy, Cairo, Egypt.; Pulmonology department, Faculty of Medicine, Université Saad Dahlab, Blida, Algeria., Mohamed-Hussein AAR; Faculty of Medicine, Assiut University, Assiut, Egypt. aliaehussein@aun.edu.eg.; Pulmonology, Chest Department, Faculty of Medicine, Assiut University, Assiut, 71515, Egypt. aliaehussein@aun.edu.eg.
Jazyk: angličtina
Zdroj: Sleep & breathing = Schlaf & Atmung [Sleep Breath] 2024 Dec 23; Vol. 29 (1), pp. 63. Date of Electronic Publication: 2024 Dec 23.
DOI: 10.1007/s11325-024-03227-6
Abstrakt: Purpose: Noradrenergics and antimuscarinics have been proposed as future pharmacotherapy for obstructive sleep apnea (OSA). However, the available randomized controlled trials (RCTs) showed heterogeneous results regarding the safety and efficacy of the combined regimen in OSA. Therefore, we performed this meta-analysis from the published RCTs to clarify this conflicting evidence.
Methods: A systematic search of four electronic databases was done till December 2023.
Results: Thirteen RCTs (n = 345) were systematically reviewed and meta-analyzed. The combined regimen significantly reduced apnea-hypopnea index (AHI): AHI 3% [events/h; Mean difference (MD): - 6.30; 95% Confidence interval (CI) (- 9.74, - 2.87); P = 0.0003], AHI 4% [events/h; MD: - 6.50; 95% CI (- 8.74, - 4.26 events/h); P < 0.00001]. All gasometric measures significantly improved in the combined regimen group except mean SpO2. No difference was found in total sleep time between the treatment and placebo. However, compared to placebo, the combined regimen altered sleep architecture and decreased sleep efficiency. Regarding OSA endotypes, the combined regimen significantly improved loop gain, pharyngeal muscle compensation, pharyngeal muscle recruitment, and respiratory arousal threshold.
Conclusion: The combined regimen effectively reduces AHI and OSA severity with improvement in almost all OSA endotypes. However, this regimen decreased sleep efficiency and altered sleep architecture. Short-term side effects can be confined to increased heart rate, dry mouth and urinary hesitancy. Therefore, noradrenergics and anti-muscarinics is a promising regimen for treating OSA, yet this optimism must be titrated by the lack of long-term effects of the regimen. Future RCTs with focus on the long-term efficacy of the regimen and cardiovascular outcomes is recommended.
Competing Interests: Declarations. Ethical approval: This article does not contain any studies with human participants performed by any of the authors. Conflict of interest: All authors certify that they have no affiliations with or involvement in any organization or entity with any financial interest (such as honoraria; educational grants; participation in speakers' bureaus; membership, employment, consultancies, stock ownership, or other equity interest; and expert testimony or patent-licensing arrangements), or non-financial interest (such as personal or professional relationships, affiliations, knowledge or beliefs) in the subject matter or materials discussed in this manuscript.
(© 2024. The Author(s), under exclusive licence to Springer Nature Switzerland AG.)
Databáze: MEDLINE
Externí odkaz: