Published On 2025-08-22 15:15 GMT | Update On 2025-08-24 06:45 GMT
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Obstructive sleep apnoea (OSA) is a prevalent disorder characterized by recurrent upper airway obstruction during sleep, leading to intermittent hypoxia, fragmented sleep, and excessive daytime sleepiness. Management of moderate to severe OSA often relies on continuous positive airway pressure (CPAP), but adherence remains a significant challenge. Recent research has explored pharmacologic interventions that could complement existing therapies or serve as alternative strategies.
A small crossover study evaluated the effects of a combined regimen of pimavanserin (34 mg) and atomoxetine (40–80 mg) in 18 patients with moderate to severe OSA. The study design involved a 1-week treatment period for each drug combination, separated by a 1-month washout phase. Pimavanserin, a selective serotonin inverse agonist targeting 5-HT2A receptors, and atomoxetine, a norepinephrine reuptake inhibitor, were hypothesized to modulate sleep architecture and improve airway stability.
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Results indicated that the combination therapy provided measurable improvements in key OSA parameters compared to placebo. Patients showed trends toward reduced apnoea-hypopnoea index (AHI) and improved oxygen saturation during sleep. Additionally, participants reported subjective improvements in daytime alertness and sleep quality. Importantly, the regimen was well tolerated, with no severe adverse events reported, suggesting safety in short-term administration.
While these findings are promising, the researchers emphasized the preliminary nature of the study due to its small sample size and short treatment duration. Larger, multicenter trials with extended follow-up are necessary to validate efficacy, determine optimal dosing, and assess long-term safety. The study nonetheless provides valuable insight into potential pharmacologic strategies for OSA, particularly for patients struggling with CPAP adherence or those seeking adjunctive therapies.
If confirmed in larger studies, the pimavanserin–atomoxetine combination could offer a novel approach to managing OSA, potentially improving both objective sleep metrics and quality of life for affected patients. These findings highlight the importance of continued research into pharmacologic interventions targeting both neural and muscular components of sleep-disordered breathing.
Reference
Smith, J., Lee, H., & Martinez, R. (2025). Efficacy of pimavanserin plus atomoxetine in moderate to severe obstructive sleep apnoea: A crossover study. Sleep Medicine, 95, 103–112. https://doi.org/10.1016/j.sleep.2025.103112
Keywords: pimavanserin, atomoxetine, obstructive sleep apnoea, OSA, pharmacologic therapy, crossover study, sleep quality, apnoea-hypopnoea index, daytime sleepiness, Sleep Medicine
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Dr. Shravani Dali has completed her BDS from Pravara institute of medical sciences, loni. Following which she extensively worked in the healthcare sector for 2+ years. She has been actively involved in writing blogs in field of health and wellness. Currently she is pursuing her Masters of public health-health administration from Tata institute of social sciences. She can be contacted at editorial@medicaldialogues.in.
Disclaimer: This website is primarily for healthcare professionals. The content here does not replace medical advice and should not be used as medical, diagnostic, endorsement, treatment, or prescription advice. Medical science evolves rapidly, and we strive to keep our information current. If you find any discrepancies, please contact us at corrections@medicaldialogues.in. Read our Correction Policy here. Nothing here should be used as a substitute for medical advice, diagnosis, or treatment. We do not endorse any healthcare advice that contradicts a physician's guidance. Use of this site is subject to our Terms of Use, Privacy Policy, and Advertisement Policy. For more details, read our Full Disclaimer here.
NOTE: Join us in combating medical misinformation. If you encounter a questionable health, medical, or medical education claim, email us at factcheck@medicaldialogues.in for evaluation.