Introduction
sleep disorders, OSA
OBSTRUCTIVE SLEEP APNEA
Obstructive sleep apnea (OSA) is one of the most common sleep disorders affecting one-third of the population aged 30–70 years in EuropeIn the last 40 years, the gold standard for OSA treatment has been nocturnal ventilation through continuous positive airway pressure (CPAP), which acts to pneumatically splint the pharynx open. If regularly employed, CPAP therapy might reduce cardiovascular risk and overall mortality rateReduced pharyngeal dilator muscle tone and responsiveness during sleep are key contributors to OSA pathogenesisAs known, noradrenaline is the main neurotransmitter of the sympathetic nervous system and muscarinic receptors are responsible for the vagal activity. Thus, a pending issue, not yet explored, is the possibility that the administration of noradrenergic reboxetine together with antimuscarinic oxybutynin might negatively affect the autonomic control of circulationThe sympathetic and parasympathetic cardiovascular modulation can be assessed with direct measurements, or thanks to non-invasive reliable tools such as BP by 24 h ambulatory monitoring (ABPM), HR variability (HRV), and baroreceptor sensitivity (BRS)In order to assess the effect of reboxetine plus oxybutynin (reb-oxy) on cardiovascular autonomic modulation in OSA patients, we performed 24 h ABPM and estimated BRS and HRV after 1-week of treatment in the frame of our randomized controlled cross-over trial. The outcomes were evaluated as the change from baseline during the week of reb-oxy administration and compared to placebo.