Acute effects of paroxetine on genioglossus activity in obstructive sleep apnea

Study Objective: To determine the acute effects of paroxetine on genioglossus activity during NREM sleep. Design: A single dose of Paroxetine (40 mg) or placebo was administered four hours before bedtime on nights separated by one week in a double blind randomized crossover manner. The moving time average of genioglossus muscle activity (EMGgg) expressed as a percentage of maximum was measured using a mouthpiece electrode customized for each subject. The peak inspiratory and tonic values of EMGgg and the corresponding esophageal pressure deflections (DP) during the last three occluded breaths of obstructive apneas during NREM 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 versus 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 + hypopnea index (paroxetine: 75.2+/-5.5 versus placebo: 73.7+/-6.9 events 1 hour) did not differ. Conclusions: Paroxetine augmented peak inspiratory genioglossus activity during NREM sleep but this effect was not sufficient to decrease the frequency of obstructive apnea in this group with severe OSA.