The effects of protriptyline in sleep-disordered breathing

Area of Science:

• Sleep Medicine
• Pharmacology
• Pulmonology

Background:

• Obstructive sleep apnea (OSA) is a common disorder characterized by repeated episodes of upper airway collapse during sleep.
• Hypersomnolence is a frequent symptom of OSA, impacting daytime functioning.
• Current treatment options for OSA include continuous positive airway pressure (CPAP) and surgery.

Purpose of the Study:

• To investigate the efficacy of protriptyline, a tricyclic antidepressant, in treating hypersomnolence and sleep-disordered breathing (SDB) in patients with moderately severe OSA.
• To assess the effects of protriptyline on breathing patterns, oxygen saturation, and subjective sleepiness.

Main Methods:

• A study involving 12 patients diagnosed with hypersomnolence and moderately severe OSA.
• Patients received treatment with protriptyline.
• Sleep studies were conducted to monitor sleep-disordered breathing (SDB) patterns, including apnea events and oxygen saturation.
• Subjective assessments of daytime hypersomnolence were recorded.

Main Results:

• Protriptyline significantly reduced the percentage of apnea during sleep-disordered breathing events (from 60.4% to 35.5%) and decreased peak oxygen desaturation.
• While SDB during REM sleep was unchanged, a reduction in REM sleep duration decreased severe SDB events and improved nocturnal oxygenation.
• Ten out of 12 patients reported subjective improvement in daytime hypersomnolence, correlated with increased sleep onset latency.
• Common side effects included dry mouth, with some patients experiencing urinary hesitancy, constipation, or erectile dysfunction.

Conclusions:

• Protriptyline effectively reduces daytime hypersomnolence in patients with moderately severe OSA.
• The drug alters SDB patterns, improving gas exchange and nocturnal oxygenation.
• Protriptyline presents a viable alternative to surgical interventions like tracheostomy for select OSA patients.