Chest
Volume 101, Issue 3, March 1992, Pages 753-757
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Theophylline in Obstructive Sleep Apnea: A Double-Blind Evaluation

https://doi.org/10.1378/chest.101.3.753Get rights and content

Twelve patients with documented obstructive sleep apnea were enrolled in a double-blind placebo controlled crossover trial of oral theophylline, (Uniphyllin) 800 mg, taken at night for four weeks. Overnight polysomnography, using standard techniques, was performed at the end of each treatment period. The total number of apneas (A) and hypopneas (H) decreased significantly while receiving theophylline compared to placebo, from 398 (69), mean (SEM), to 283 (72), p<0.01. Sleep quality was, however, significantly worse while receiving theophylline. Obstructive A and H were very much decreased with theophylline (p<.001), and even when the data were adjusted for the more disturbed sleep with theophylline, this decrease remained significant; the obstructive A and H index fell from 49 (8.7) on placebo to 40 (9) while receiving theophylline, p=0.02. There was no difference in the numbers of central or mixed A and H, and mean A and H duration was unchanged on the two study nights. Oxygen desaturations >4 percent were less with theophylline treatment (p=0.02), but mean overnight SaO2 was unchanged. We conclude that theophylline may be beneficial in patients with OSA, but part of the improvement is due to a deterioration in sleep quality.

Section snippets

Patient Selection

Twelve male patients with recently diagnosed OSA (>15 apneas or hypopneas per hour of sleep) were enrolled in the study. Patients with a history of cardiac or hepatic disorders were excluded, as were those taking hypnotics or sedatives, or any medication known to interfere with the absorption or metabolism of theophylline. Patients with a substantial alcohol intake (>20 units per week) were also excluded. The study was approved by the Hospital Ethics Committee, and all patients gave informed

RESULTS

Nine patients completed the trial, and the anthropometric and spirometric data for these patients are presented in Table 1. They were all above ideal body weight for height, and two were morbidly obese. They had established OSA of varying severity prior to entry into the study, with an A+H index ranging from 25 to 100. Some of the patients also had mixed and a small number of central apneas, but all had predominantly obstructive disease. All had excessive daytime sleepiness of varying severity.

DISCUSSION

The main finding of this study was that theophylline significantly reduced the number of apneas and hypopneas during sleep with obstructive apneas being preferentially reduced. When these data are corrected for the deterioration in sleep quality while receiving theophylline, the frequency of obstructive apneas and hypopneas remains significantly lower with theophylline than placebo. These findings differ from those of Espinoza and colleagues,1 who in a placebo-controlled trial of a single

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    Reprint requests: Dr. McNicholas, St. Vincents Hospital, Dublin 4, Ireland

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