A recent clinical trial has found that sulthiame, a drug used to treat epilepsy, could be effective in reducing symptoms of obstructive sleep apnea (OSA), a condition that affects millions of people worldwide. The study, presented at the European Respiratory Society (ERS) Congress in Vienna, offers new hope for those who cannot tolerate traditional mechanical treatments, such as continuous positive airway pressure (CPAP) machines.
Obstructive sleep apnea, a condition that causes intermittent interruptions in breathing during the night, is more common than many people think. People who suffer from it often snore loudly, experience pauses in breathing, and wake up several times during the night, which not only causes daytime fatigue but also increases the risk of serious conditions such as high blood pressure, stroke, and heart problems. Despite its prevalence, many patients are unaware that they suffer from it.
A new therapeutic approach for sleep apnea
Professor Jan Hedner, from Sahlgrenska University Hospital and the University of Gothenburg, explained that CPAP is the standard treatment for OSA – a machine that blows air through a mask to keep the airways open – but many patients find these machines uncomfortable or difficult to use long-term. “Unfortunately, many people find these machines difficult to use long-term, so alternative treatments need to be found. We also need to better understand the underlying mechanisms of obstructive sleep apnoea to help doctors offer more personalised treatment,” said Hedner.
In this clinical trial, which included 298 patients from 28 different centres in five European countries (Spain, France, Belgium, Germany and the Czech Republic), participants who were intolerant to CPAP or who refused to use continuous positive airway pressure machines were treated with different doses of sulthiame or a placebo. 74 people took 100 mg of sulthiame daily, 74 took 200 mg, 75 took 300 mg and the remaining 75 took a placebo pill. Sulthiame works by inhibiting the enzyme carbonic anhydrase, which helps stimulate the muscles of the upper airways. After 12 weeks, the results were encouraging: patients taking sulthiame showed a significant reduction in nocturnal breathing pauses and an improvement in blood oxygen levels.
The study measured the number of breathing pauses using the AHI3a index, which showed a 17.8% reduction in patients taking the lowest dose of sulthiame, 34.8% in those taking the middle dose, and 39.9% in those taking the highest dose. Using another index, AHI4, the reduction in breathing pauses reached almost 50%. In addition, patients reported feeling less sleepy during the day, one of the most debilitating symptoms of OSA.
People who took the highest doses of sulthiame had almost 40% fewer pauses in breathing and higher blood oxygen levels during sleep.
Side effects of sulthiame treatment, including tingling, headache and fatigue, were mild to moderate, suggesting the drug could be a viable option for those who cannot tolerate traditional treatments.
“Although sulthiame is already available as a treatment for childhood epilepsy, we still need to conduct a phase III study to confirm the beneficial respiratory effects of this drug in a broader group of patients with OSA,” Hedner said.
Professor Sophia Schiza, Professor of Respiratory and Sleep Medicine at the Faculty of Medicine, University of Crete, Greece, who was not involved in the research, added: “This is one of the first studies to suggest that a drug treatment might help some patients, and the results are promising. We need to continue testing sulthiame and other treatments to understand their long-term effects, including side effects. For example, we would like to see whether the treatment can help lower blood pressure and prevent cardiovascular disease in people with obstructive sleep apnoea.”
The impact of sleep apnea on the lives of those affected
Obstructive sleep apnea not only affects nighttime rest, but also has long-term health consequences. People with untreated OSA are at increased risk of developing problems such as high blood pressure, heart and metabolic diseases, and an increased risk of stroke. In addition, this condition is often associated with loud snoring and daytime sleepiness, which affects the quality of life of those who suffer from it.
Diagnosing and treating OSA is crucial, as it can help prevent these complications. However, as Schiza points out, current treatments do not work for everyone. The development of pharmacological options, such as sulthiame, could be a game-changer in the way OSA is treated and improve the lives of millions of people.
This study offers a new avenue of hope, although further research is still needed to confirm these findings and assess whether this treatment can be a safe and effective long-term alternative. In the meantime, experts agree that sleep apnea remains a condition that needs to be addressed urgently and in a personalized manner.
Source: European Respiratory Society (ERS)
