Medroxyprogesterone acetate and ethanol-induced exacerbation of obstructive sleep apnea

To determine if medroxyprogesterone acetate (MPA) can block the ethanol-induced worsening of obstructive sleep apnea.

Randomized, double-blind, placebo-controlled, crossover trial with 1 week treatment periods.

A university-based pulmonary sleep laboratory.

Fourteen patients with previously diagnosed obstructive sleep apnea not currently receiving any form of therapy for the disorder. Eight patients completed the entire protocol.

Baseline overnight polysomnography was performed. On the second study night, subjects ingested 1 ml/kg body weight 50 percent ethanol prior to repeat overnight polysomnography. If sleep apnea worsened, subjects then received either MPA (20 mg by mouth, three times a day) or placebo for 7 days then underwent repeat polysomnography with the same ethanol dose. A washout period followed, then, the other drug was taken, followed again by polysomnography with antecedent ethanol ingestion.

Apnea-hypopnea indices (AHI) increased from 9.6 +/- 5.3 events/h (baseline) to 20.2 +/- 16.0 events/h on the ethanol night (p = 0.03). Low oxygen saturation (SaO2) fell to 79.2 +/- 5.1 percent on the ethanol night compared to baseline, 85.0 +/- 3.7 percent (p < 0.01). MPA improved AHI, nonrapid eye movement AHI, low SaO2, mean saturation nadir, number of desaturations between 80 and 90 percent, and the mean event desaturation when compared with the ethanol alone night. All these parameters were likewise improved when compared with placebo, although only the mean saturation nadir showed statistical significance. These findings were unchanged when also examined for the initial 3 hours of study.

In obstructive sleep apnea patients whose disease is made worse by ethanol ingestion, MPA appears to improve oxygenation during obstructive events but not to improve their number or length.