- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT04115878
Medications for Obstructive Sleep Apnea In Children With Down Syndrome (MOSAIC)
Evaluation of Atomoxetine and Oxybutynin for Obstructive Sleep Apnea in Children With Down Syndrome
This is a randomized, double blind, cross-over study of the combination of atomoxetine and oxybutynin (ato-oxy) in children with DS and OSA documented by polysomnography (PSG). Participants will receive high dose ato-oxy for four weeks as well as low dose ato-oxy for four weeks in random order. During the high dose ato-oxy period, participants will take 5 mg oxybutynin and 0.5mg/kg/day (max 40 mg) atomoxetine nightly for one week. Atomoxetine dose will then be increased to 1.2 mg/kg/day (max 80 mg). During the low dose ato-oxy period, participants will take 5 mg oxybutynin and 0.5mg/kg/day (max 40 mg) atomoxetine. Dosing of the study treatment will occur approximately 30 minutes prior to bedtime. Participants who withdraw from the study will not be replaced.
Study participants will undergo eligibility screening that will include an initial screening to determine whether non- PSG enrollment criteria are met, followed by a 1 night in-lab PSG and health-related quality of life assessment for participants who qualify based on non-PSG criteria. For participants who are eligible and enroll in the study, the screening PSG night will serve as the baseline measure for apnea hypopnea index (AHI) and other PSG endpoints. On the final night of dosing for both high dose ato-oxy and low-dose ato-oxy, participants will return for inpatient PSG and health-related quality of life assessment. The primary efficacy endpoint is the change in obstructive AHI from baseline (high dose ato-oxy vs. low dose ato-oxy).
Study Overview
Status
Conditions
Intervention / Treatment
Study Type
Enrollment (Actual)
Phase
- Phase 2
Contacts and Locations
Study Locations
-
-
Arizona
-
Tucson, Arizona, United States, 85721
- University of Arizona
-
-
Participation Criteria
Eligibility Criteria
Ages Eligible for Study
Accepts Healthy Volunteers
Description
Inclusion Criteria:
- Male or female participants between 6 to 17 years of age, inclusive, at the Screening Visit. Enrollment will be stratified to ensure equal representation of children age 6-12 and age 13-17. No more than 14 subjects will be randomized for each age group.
- Known diagnosis of Down syndrome (trisomy 21, but not translocation or mosaicism)
Exclusion Criteria:
- Hypoxemia independent of respiratory events on polysomnography (≥5 minutes with oxygen saturation <90%)
- Presence of central sleep apnea on polysomnography (central AHI ≥ 5)
- Currently using and adherent to PAP therapy (>4 hours per night for 70% of nights in the past 30 days based on device download or parent report)
- MAO inhibitor use
- Urinary retention
- Prematurity < 37 weeks estimated gestational age
- Seizure disorder
- Untreated or inadequately treated hypothyroidism
- Significant traumatic brain injury
- Congenital heart disease and not cleared to participate by the patient's cardiologist
- History of current, untreated depression
- History of liver disease
- 3+ or greater tonsillar hypertrophy.
Study Plan
How is the study designed?
Design Details
- Primary Purpose: Treatment
- Allocation: Randomized
- Interventional Model: Crossover Assignment
- Masking: Quadruple
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
---|---|
Active Comparator: High dose ato-oxy
|
Low dose ato-oxy will include 0.5 mg/kg/day of atomoxetine (max 40 mg) in combination with 5 mg oxybutynin High dose ato-oxy will include 1.2 mg/kg/day atomoxetine (max 80 mg) and 5 mg oxybutynin
|
Active Comparator: Low dose ato-oxy
|
Low dose ato-oxy will include 0.5 mg/kg/day of atomoxetine (max 40 mg) in combination with 5 mg oxybutynin High dose ato-oxy will include 1.2 mg/kg/day atomoxetine (max 80 mg) and 5 mg oxybutynin
|
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
obstructive apnea-hypopnea index (oAHI)
Time Frame: four weeks
|
change in number of obstructive apneas and hypopneas per hour on polysomnography from baseline (% change)
|
four weeks
|
Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Obstructive Sleep Apnea-18 score (OSA-18)
Time Frame: four weeks
|
Change in OSA-18 (a measure of health-related quality of life) from baseline.
The OSA-18 score ranges from 18 to 136, with lower scores indicating better health-related quality of life.
|
four weeks
|
Arousal Index
Time Frame: four weeks
|
change in number of arousals per hour on polysomnography from baseline
|
four weeks
|
Other Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Pediatric Quality of Life Inventory (PedsQL) total score
Time Frame: four weeks
|
Change in PedsQL total score (a measure of health-related quality of life) from baseline.
The PedsQL score ranges from 0-100, with higher scores indicating better health-related quality of life.
|
four weeks
|
Caregiver Global Impression of Change
Time Frame: four weeks
|
Change in Caregiver Global Impression of Change from baseline.
This will be assessed on a seven point scale answering the question: Since the start of this therapy, my child's overall status is: 1. Very much improved; 2. Much improved; 3. Minimally Improved; 4. No change; 5. Minimally worse; 6.
Much worse or 7. Very much worse.
|
four weeks
|
N1 sleep percentage
Time Frame: four weeks
|
Change in N1 sleep percentage on polysomnography from baseline
|
four weeks
|
REM sleep percentage
Time Frame: four weeks
|
Change in REM sleep percentage on polysomnography from baseline
|
four weeks
|
N3 sleep percentage
Time Frame: four weeks
|
Change in N3 sleep percentage on polysomnography from baseline
|
four weeks
|
Collaborators and Investigators
Sponsor
Collaborators
Investigators
- Principal Investigator: Daniel Combs, MD, University of Arizona
Study record dates
Study Major Dates
Study Start (Actual)
Primary Completion (Actual)
Study Completion (Actual)
Study Registration Dates
First Submitted
First Submitted That Met QC Criteria
First Posted (Actual)
Study Record Updates
Last Update Posted (Actual)
Last Update Submitted That Met QC Criteria
Last Verified
More Information
Terms related to this study
Keywords
Additional Relevant MeSH Terms
- Pathologic Processes
- Nervous System Diseases
- Respiratory Tract Diseases
- Respiration Disorders
- Sleep Disorders, Intrinsic
- Dyssomnias
- Sleep Wake Disorders
- Neurologic Manifestations
- Neurobehavioral Manifestations
- Disease
- Congenital Abnormalities
- Genetic Diseases, Inborn
- Signs and Symptoms, Respiratory
- Intellectual Disability
- Abnormalities, Multiple
- Chromosome Disorders
- Sleep Apnea Syndromes
- Sleep Apnea, Obstructive
- Syndrome
- Apnea
- Down Syndrome
- Physiological Effects of Drugs
- Adrenergic Agents
- Neurotransmitter Agents
- Molecular Mechanisms of Pharmacological Action
- Parasympatholytics
- Autonomic Agents
- Peripheral Nervous System Agents
- Muscarinic Antagonists
- Cholinergic Antagonists
- Cholinergic Agents
- Urological Agents
- Neurotransmitter Uptake Inhibitors
- Membrane Transport Modulators
- Adrenergic Uptake Inhibitors
- Oxybutynin
- Atomoxetine Hydrochloride
Other Study ID Numbers
- 1908864846
- R61HL151254 (U.S. NIH Grant/Contract)
Plan for Individual participant data (IPD)
Plan to Share Individual Participant Data (IPD)?
Drug and device information, study documents
Studies a U.S. FDA-regulated drug product
Studies a U.S. FDA-regulated device product
product manufactured in and exported from the U.S.
This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.
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