Acute effects of paroxetine on genioglossus activity in obstructive sleep apnea

Study Objective: To determine the acute effects of paroxetine on geniogloss us activity during NREM sleep. Design: A single dose of Paroxetine (40 mg) or placebo was administered fou r hours before bedtime on nights separated by one week in a double blind ra ndomized crossover manner. The moving time average of genioglossus muscle a ctivity (EMGgg) expressed as a percentage of maximum was measured using a m outhpiece electrode customized for each subject. The peak inspiratory and t onic values of EMGgg and the corresponding esophageal pressure deflections (DP) during the last three occluded breaths of obstructive apneas during NR EM sleep were analyzed. Setting: NA Participants: 8 adult men with severe obstructive sleep apnea (OSA). Interventions: NA Measurements and Results: Paroxetine increased the peak inspiratory EMGgg ( 29.8+/-2.4 (SE) versus 24.4+/-2.7 % max, p<0.05) and peak EMGgg / DP ratio (0.78+/-0.12 versus 0.65+/-0.11 % max / cm H2O, p < 0.01) but not the tonic EMGgg (11.6+/-0.9 versus 9.8 +/- 0.7 % max) nor the DP (39.4 +/- 2.2 versu s 38.2 +/- 2.8 cm H2O). Linear regression analysis of the peak inspiratory EMGgg versus DP relationship showed that paroxetine increased the slope (0. 62+/-0.11 versus 0.49+/-0.09 %max / cm H2O, p<0.01), However, the apnea + h ypopnea index (paroxetine: 75.2+/-5.5 versus placebo: 73.7+/-6.9 events 1 h our) did not differ. Conclusions: Paroxetine augmented peak inspiratory genioglossus activity du ring NREM sleep but this effect was not sufficient to decrease the frequenc y of obstructive apnea in this group with severe OSA.