MEDROXYPROGESTERONE ACETATE AND ETHANOL-INDUCED EXACERBATION OF OBSTRUCTIVE SLEEP-APNEA

Objective: To determine if medroxyprogesterone acetate (MPA) can block the ethanol-induced worsening of obstructive sleep apnea. Design: Ran domized, double-blind, placebo-controlled, crossover trial with 1 week treatment periods. Setting: A university-based pulmonary sleep labora tory. Patients: Fourteen patients with previously diagnosed obstructiv e sleep apnea not currently receiving any form of therapy for the diso rder. Eight patients completed the entire protocol. Interventions: Bas eline overnight polysomnography was performed. On the second study nig ht, subjects ingested 1 ml/kg body weight 50 percent ethanol prior to repeat overnight polysomnography. If sleep apnea worsened, subjects th en 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, foll owed again by polysomnography with antecedant ethanol ingestion. Measu rements and results: 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 (SaO(2)) 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 SaO(2), mean saturati on nadir, number of desaturations between 80 and 90 percent, and the m ean event desaturation when compared with the ethanol alone night. All these parameters were likewise improved when compared with placebo, a lthough only the mean saturation nadir showed statistical significance . These findings were unchanged when also examined for the initial 3 h ours of study. Conclusions: In obstructive sleep apnea patients whose disease is made worse by ethanol ingestion, MPA appears to improve oxy genation during obstructive events but not to improve their number or length.