Sleep apnea is a relatively common condition. It manifests itself by repeated closures of the pharynx during sleep. The person who suffers from it thus experiences brief interruptions in breathing (apneas) and incessant micro-awakenings. This has significant social and medical consequences: snoring, daytime sleepiness, irritability, cardiovascular disorders, etc. Researchers have discovered that an epilepsy medication could help prevent these apneas. Good news for those who cannot tolerate continuous positive airway pressure treatment.
Sleep apnea syndrome is caused by a relaxation of the muscles in the walls of the throat (the pharynx). Air passes through it with more difficulty, which causes vibrations that cause snoring. When the pharynx closes completely, breathing is interrupted and the body is in apnea. An alert system is then triggered in the brain and causes a micro-awakening, of which the person is not aware. Some patients experience several dozen, even several hundred apneas during a night!
In France, this syndrome affects nearly 4% of the population, mostly men. Many people are unaware that they have it. In addition to gender, factors that predispose to the development of sleep apnea are obesity and age – 30% of people over 65 are affected. With age, the muscles of the upper airways become less toned, which promotes the onset of the syndrome. The shape of the throat and mandible (retrognathism) is another risk factor. Drinking alcohol or sleeping on your back will also promote the occurrence of apnea.
Harmful consequences, in the short and long term
Apart from a noise nuisance for the spouse (snoring can reach 70 to 100 dB!), sleep apnea has significant consequences on the health of the person who suffers from it. Due to repeated micro-awakenings, sleep is not restorative. When waking up, the person does not feel rested and may experience headaches. In addition, daytime sleepiness can occur, which increases the risk of accidents. This permanent fatigue leads to difficulty concentrating and memorizing, as well as mood disorders (irritability).
If left untreated, the syndrome also has longer-term consequences. People who suffer from sleep apnea are indeed more prone to cardiovascular and metabolic disorders. The risk of high blood pressure, atherosclerosis and type 2 diabetes is increased. These complications, in turn, lead to an increased risk of myocardial infarction or stroke.
Measures to improve lifestyle are recommended as a first-line treatment. This mainly involves losing weight and increasing physical activity. Then, the standard treatment for obstructive sleep apnea is to sleep with a continuous positive airway pressure (CPAP) machine. This machine sends air continuously, through a face mask, to keep the airway open (and prevent the pharynx from collapsing).
Sleeping with a mask connected to a machine all night is however extremely restrictive. As a result, many patients abandon CPAP after a few months of use. It is therefore necessary to find alternative treatments. It is in this context that an international team of researchers recently discovered that an anti-epileptic drug could prove useful.
Respiratory arrests reduced by almost 50%
Sultiame – marketed under the name Ospolot – is widely used as an anti-epileptic drug in Europe. It is an inhibitor of the enzyme carbonic anhydrase. In France, it is indicated for the treatment of continuous spike-wave syndrome in sleep (a rare childhood epileptic encephalopathy).
Researchers conducted a randomized controlled trial on nearly 300 patients with obstructive sleep apnea, treated in 28 different centers in Spain, France, Belgium, Germany and the Czech Republic. These people could not tolerate or refused to use a CPAP machine. They were divided into four groups and then received one of three doses of sultiame (100, 200 or 300 mg per day) or a placebo.
The team monitored the patients' breathing, blood oxygen levels, heart rate, eye movements, and brain and muscle activity while they slept. These parameters were recorded at the start of the trial, after four weeks, and then after 12 weeks. The results of this study were presented at the European Respiratory Society congress, which took place from September 7 to 11 in Vienna.
The researchers found that sultiame led to a significant reduction in sleep apnea symptoms. They report that after 12 weeks, patients on treatment had up to 50% fewer respiratory arrests and higher blood oxygen levels during sleep. Patients also reported feeling less daytime sleepiness while taking the drug.
These effects were dose-dependent: the higher the dose of sultiame, the more symptoms were reduced. The drug works by stimulating the muscles of the upper airways.
A first step towards alternative therapies
Sultiame therefore appears to be an effective treatment for sleep apnea. However, further studies are needed to confirm the beneficial effects of this drug in a larger number of patients and over the long term. It is also a question of identifying specific types of patients who would benefit more from the treatment.
This antiepileptic drug has several contraindications and is not without potential adverse effects (affecting in particular the nervous and digestive systems). Participants in the trial reported paresthesia or tingling, headaches, fatigue and nausea. These symptoms were generally mild or moderate.
This study is thus a first step towards abandoning respiratory devices in favor of drug treatment. “This potential alternative to the current mainstay treatment would make it easier for patients to manage their condition,” Erika Radford, head of health advice at Asthma + Lung UK, told the Guardian. Other approaches, including nerve stimulation and muscle training, are gaining interest.
However, some experts caution that in the majority of cases, sleep apnoea is linked to obesity. For Dr. Sriram Iyer, consultant physician in pulmonology and sleep medicine, it should therefore be a priority to tackle this problem. Obesity is indeed a major risk factor for sleep apnea, as fatty deposits around the pharynx cause a narrowing of the airways. According to Inserm, more than 60% of individuals with metabolic syndrome (combining abdominal obesity and metabolic disorders) suffer from sleep apnea syndrome.
With an unwavering passion for local news, Christopher leads our editorial team with integrity and dedication. With over 20 years’ experience, he is the backbone of Wouldsayso, ensuring that we stay true to our mission to inform.
