William R prepare for the table M....

William R prepare for the table M.D., F.C.C.P.; Joseph J. Benich, D.B.A.; and sally A. Wooten MD

Medroxyprogesterone acetate (MPA) could change the frequent occurrence and/or duration of disordered breathing adventures (DBEs) in patients with the obstructive repose apnea (OSA) syndrome by altering pharyngeal muscle function relative to diaphragm and external intercostal function. Ten male patients with OSA syndrome underwent an initial polysomnogram with monitoring of EEG EOG myohyoid EMG oral and nasal airflow, abdominal and thoracic move and [SaO.sub.2]. The patients were then set downed into a randomized, double-blind crossover thought using MPA, 150 mg/day, and MPA placebo. Each patient took tablets for the same week and then had a inferior polysomnogram. After a three week washout, the patient again took tablets for a week prior to the third and final be still study. There was no significant difference between mix with drugs and placebo for DBE time (express as a percentage of be dead time), DBE frequency, DBE mean duration or mean fall in [Osub2] saturation during DBEs. We decide that treatment with MPA does not alter indices of severity of the OSA syndrome

Inadequate function of the pharyngeal muscles during rest probably contributes to the growth of obstructive apnea. These muscles normally stabilize the upper airway during inspiration, while contraction of the diaphragm and external intercostal muscles minds to collapse the pharynx during inspiration. Medroxyprogesterone acetate, a unsalable article that has been shown to increase minute ventilation and to exhibit hypocapnia in normal subjects[1] and in patients with obesity,[2] might 1 and 2 an effect on respiratory muscles in a way that increases pharyngeal muscle contraction more than diaphragm and intercostal contraction. This might increase stability of the upper airway during repose and decrease the frequency and/or duration of obstructive apnea. reciprocally if MPA should exert a greater drift on diaphragm and intercostal function than forward pharyngeal stabilizer function, the frequent occurrence and/or duration of apnea might be increased. Thirdly, if the put drugs into has equal effects on as well-as; not only-but also; not only-but; not alone-but groups of muscles or no powers on either muscle group, then the commonness and/or duration of apnea might not change.

While the use of MPA therapy for patients with the OSA syndrome[3-5] and for postmenopausal females[6] has been studied, the proceeds regarding the efficacy of the remedy are not consistent. The project of this study was to determine whether MPA therapy at higher dosage horizontals has any significant effect forward the indices of severity of OSA syndrome

METHODS

Studies were made of ten male patients who had been referr to our outpatient department for excessive daytime sleepiness and suspected OSA syndrome Each patient gave informed compliance using forms approved by the institutional committee forward human research. Pulmonary function and arterial house gas studies were obtained for each patient. All patients underwent an initial polysomnogram that confirmed the diagnosis of OSA syndrome To the best of our knowledge, none of the patients in this cogitation took alcohol or sedative mix with drugss during the study period. All patients were studied while they were breathing scope air except for patient 10 who was studied forward [O.sub.2] by nasal cannulae. All polysomnograms included the following: EEG EOG myohyoid EMG ECG and arterial oxygen saturation ([SaO.sub.2]) using a oscillation oximeter. The presence of airflow was determined using thermistors, undivided placed at the nose and the other at the aperture Abdominal and thoracic motion were detected using pneumographs. The respiratory variables were continuously recorded onward a multiple channel strip recorder. The EEG EOG and chin surface EMG were recorded in succession a polygraphic recorder.

The studies were scored in 20 next to the first epochs, using standard criteria.[8] Obstructive apnea was diagnosed when there was absence of airflow at the nose and jaws for ten seconds or longer coupl with evidence for abdominal and thoracic manner of moving Absence of airflow for ten secondarys with no evidence for respiratory effort was called central apnea. Mixed apnea consisted of no airflow with no respiratory effort initially, followed by dint of respiratory movement. Hypopnea consisted of reduc amplitude of the oral and/or nasal thermistor tracing, coupl with a reduction in [SaO.sub.2] of 4 percent or greater. All of the above consequences were grouped together and referr to as DBEs. The diagnosis of OSA syndrome was made when a patient with a complaint of excessive daytime sleepiness was build to have at least 30 DBE by night, either apneas or hypopneas, during the two REM sleep and NREM sleep[9] [TABULAR DATA OMITTED]

Following the initial studies, the patients were enrolled into a randomized, double-blind crossover thought Since earlier investigators had performed studies using doses of MPA ranging from 60 to 120 mg by means of day, we chose a somewhat larger does of 150 mg by day. The patients were randomly assigned to take MPA, 50 mg tid for common week or placebo for undivided week. We chose to administer this unsalable article for a period of single in kind week because an earlier cogitation showed that substantial plasma plains and maximal respiratory effects are generally achieved after united week in normal individuals.[1] All patients took medication onward an outpatient basis except for patient number 8 who was hospitalized during the one and the other medication periods. At the finis of one week, a repeat polysomnogram was obtained. The patients were weighed in the morning after the polysomnogram, and venous relations was obtained for MPA and testosterone level