Rescue Pharmacotherapy for Obstructive Sleep Apnea
(RescOSA Trial)
Trial Summary
What is the purpose of this trial?
Persistent obstructive sleep apnea (OSA) is common in people treated with mandibular advancement device (MAD) or hypoglossal nerve stimulation (HGNS). For most patients, these treatments are the last line of defense. If MAD or HGNS do not work, then patients are left to suffer the consequences of undertreated OSA. In this study, the investigators want to test the addition of a drug treatment to their regimen. Endotypes will be targeted pharmacologically with one of the following drugs: acetazolamide for a high loop gain, atomoxetine-plus-eszopiclone for poor pharyngeal muscle compensation, or trazodone for a low arousal threshold. This aim is expected to provide treatment strategies for rescuing non-responders to MAD or HGNS therapy.
Will I have to stop taking my current medications?
The trial requires that you stop taking certain medications, such as those that stimulate or depress breathing (like opioids and benzodiazepines) and SSRIs/SNRIs. If you are on any of these, you would need to stop them to participate in the trial.
What evidence supports the effectiveness of the drug combination including acetazolamide and atomoxetine for treating obstructive sleep apnea?
Research indicates that acetazolamide can reduce the severity of obstructive sleep apnea (OSA) by lowering the apnea-hypopnea index, which measures breathing interruptions during sleep. Additionally, atomoxetine combined with certain other drugs has shown modest improvements in upper airway function and reduced sleepiness in OSA patients.12345
Is the treatment generally safe for humans?
Acetazolamide and eszopiclone have been studied for safety in various conditions. Acetazolamide is considered safe for improving sleep at high altitudes, while eszopiclone is approved for long-term treatment of insomnia and has been tested in over 2700 adults and elderly subjects, showing a generally safe profile.16789
How does the drug acetazolamide differ from other treatments for obstructive sleep apnea?
Acetazolamide is unique because it is a medication that can be used to treat obstructive sleep apnea (OSA) at high altitudes, where other treatments like CPAP (continuous positive airway pressure) may not be practical. It works by altering the body's acid-base balance, which can help improve breathing during sleep, especially in situations where traditional therapies are not feasible.45101112
Eligibility Criteria
This trial is for individuals with persistent obstructive sleep apnea (OSA) who haven't found relief through mandibular advancement device (MAD) or hypoglossal nerve stimulation (HGNS). Participants must have a residual AHI of ≥15 events/hr despite these treatments. People with certain medical conditions, including severe liver or kidney issues, specific heart problems, glaucoma, and those on conflicting medications like SSRIs/SNRIs are excluded.Inclusion Criteria
Exclusion Criteria
Trial Timeline
Screening
Participants are screened for eligibility to participate in the trial
Treatment
Participants receive pharmacotherapy based on their specific OSA endotype, including drugs such as acetazolamide, atomoxetine-plus-eszopiclone, or trazodone
Follow-up
Participants are monitored for safety and effectiveness after treatment
Treatment Details
Interventions
- Acetazolamide (Other)
- Atomoxetine and eszopiclone (Other)
- Placebo (Other)
- Trazodone (Other)