Pharmacological treatment of obstructive sleep apnea with a combination of pseudoephedrine and domperidone.

OBJECTIVES To determine the effect of the drug combination domperidone and pseudoephedrine on nocturnal oximetry measurements and daytime sleepiness in patients with obstructive sleep apnea. METHODS We recruited patients with severe snoring and apneic episodes willing to undergo repeated nocturnal oximetry testing. Following baseline clinical history, Epworth Sleepiness Scale administration, and home overnight nocturnal oximetry, patients were started on weight-adjusted doses of domperidone and pseudoephedrine. Follow-up oximetry studies were performed at the patient's convenience. On the final visit, a repeat clinical history, Epworth score, and oximetry were obtained. RESULTS Seventeen of 23 patients noted disappearance of snoring and apneic episodes. Another 2 patients reported improvement in snoring and no apneic episodes. All but one patient had a decrease in Epworth scores (mean decrease 9.4 (95% CI, 6.8-12.1, p < 0.0001). Mean oxygen saturation (2.5; 95% Cl, 0.66-4.41, p = 0.008), percent time with oxygen saturation < 90% (14.8; 95% CI, 24.4 to 5.2, p = 0.003), and the 4% oxygen desaturation index (18.2; 95% CI, 27.3 to 9.1, p < 0.0001) improved significantly. No adverse effects of treatment were noted. CONCLUSIONS The combination of domperidone and pseudoephedrine improved self reported snoring and sleepiness, and may have improved apneic episodes and sleep-related nocturnal oxygen desaturation in patients with obstructive sleep apnea provided the proportion of time spent asleep did not diminish. This drug combination warrants further study as a treatment for obstructive sleep apnea. KEYWORDS Obstructive sleep apnea; oximetry; sleepiness; domperidone; pseudoephedrine; pharmacotherapy; desaturation; treatment CITATION Larrain A; Kapur VK; Gooley TA; Pope CE. Pharmacological treatment of obstructive sleep apnea with a combination of pseudoephedrine and domperidone.