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Related Experiment Videos

Marked decrease in sleepiness in patients with sleep apnea by etanercept, a tumor necrosis factor-alpha antagonist.

A N Vgontzas1, E Zoumakis, H-M Lin

  • 1Department of Psychiatry H073, Pennsylvania State University College of Medicine, 500 University Drive, Hershey, Pennsylvania 17033, USA. axv3@psu.edu

The Journal of Clinical Endocrinology and Metabolism
|September 10, 2004
PubMed
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Neutralizing tumor necrosis factor-alpha (TNFalpha) with etanercept significantly reduced sleepiness and apneas in obstructive sleep apnea (OSA) patients. This suggests a role for inflammation in OSA pathogenesis and daytime sleepiness.

Area of Science:

  • Sleep Medicine
  • Immunology
  • Pharmacology

Background:

  • Elevated proinflammatory cytokines, specifically tumor necrosis factor-alpha (TNFalpha) and interleukin-6 (IL-6), are observed in obstructive sleep apnea (OSA).
  • These cytokines are hypothesized to mediate excessive daytime sleepiness in individuals with OSA.

Purpose of the Study:

  • To investigate the therapeutic effects of etanercept, a TNFalpha-neutralizing medication, on sleepiness and OSA severity.
  • To assess the impact of etanercept on inflammatory markers and metabolic parameters in obese male patients with OSA.

Main Methods:

  • A pilot, placebo-controlled, double-blind study was conducted on eight obese male patients with OSA.
  • Participants underwent nighttime polysomnography and multiple sleep latency tests.

Related Experiment Videos

  • Fasting blood glucose, IL-6, C-reactive protein, insulin, and adiponectin levels were measured.

    • Main Results:

    • Etanercept significantly reduced daytime sleepiness, increasing multiple sleep latency test sleep latency by 3.1 minutes compared to placebo (P < 0.05).
    • The number of apneas/hypopneas per hour was significantly reduced by etanercept (adjusted difference, -8.4/hour; P < 0.05).
    • Etanercept significantly decreased IL-6 levels (adjusted difference, -1.9 pg/ml; P < 0.01) but did not affect glucose, C-reactive protein, insulin, or adiponectin.

    Conclusions:

    • Neutralizing TNFalpha activity with etanercept leads to a significant reduction in objective sleepiness in obese OSA patients.
    • The observed improvement in sleepiness is approximately threefold greater than reported effects of continuous positive airway pressure.
    • These findings suggest that proinflammatory cytokines play a role in the pathogenesis of OSA and associated sleepiness.