Antioxidant Carbocysteine Treatment in Obstructive Sleep Apnea Syndrome: A Randomized Clinical Trial

Kang Wu, Xiaofen Su, Guihua Li, Nuofu Zhang, Kang Wu, Xiaofen Su, Guihua Li, Nuofu Zhang

Abstract

Objective: This study aimed to examine the effects of carbocysteine in OSAS patients.

Methods: A total of 40 patients with moderate to severe obstructive sleep apnea syndrome (OSAS) were randomly divided into two groups. One group was treated with 1500 mg carbocysteine daily, and the other was treated with continuous positive airway pressure (CPAP) at night. Before treatment and after 6 weeks of treatment, all patients underwent polysomnography and completed questionnaires. Treatment compliance was compared between the two groups. Plasma was collected for various biochemical analyses. Endothelial function was assessed with ultrasound in the carbocysteine group.

Results: The proportion of patients who fulfilled the criteria for good compliance was higher in the carbocysteine group (n = 17) than in the CPAP group (n = 11; 100% vs. 64.7%). Compared with baseline values, the carbocysteine group showed significant improvement in their Epworth Sleepiness Scale score (10.18 ± 4.28 vs. 6.82 ± 3.66; P ≤ 0.01), apnea-hypopnea index (55.34 ± 25.03 vs. 47.56 ± 27.32; P ≤ 0.01), time and percentage of 90% oxygen desaturation (12.66 (2.81; 50.01) vs. 8.9 (1.41; 39.71); P ≤ 0.01), and lowest oxygen saturation level (65.88 ± 14.86 vs. 70.41 ± 14.34; P ≤ 0.01). Similar changes were also observed in the CPAP group. The CPAP group also showed a decreased oxygen desaturation index and a significant increase in the mean oxygen saturation after treatment, but these increases were not observed in the carbocysteine group. Snoring volume parameters, such as the power spectral density, were significantly reduced in both groups after the treatments. The plasma malondialdehyde level decreased and the superoxide dismutase and nitric oxide levels increased in both groups. The endothelin-1 level decreased in the CPAP group but did not significantly change in the carbocysteine group. Ultrasonography showed that the intima-media thickness decreased (0.71 ± 0.15 vs. 0.66 ± 0.15; P ≤ 0.05) but that flow-mediated dilation did not significantly change in the carbocysteine group.

Conclusions: Oral carbocysteine slightly improves sleep disorders by attenuating oxidative stress in patients with moderate to severe OSAS. Carbocysteine may have a role in the treatment of OSAS patients with poor compliance with CPAP treatment. However, the efficiency and feasibility of carbocysteine treatment for OSAS needs further evaluation.

Trial registration: ClinicalTrials.gov NCT02015598.

Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures

Fig 1. Study plan.
Fig 1. Study plan.
PSG = Polysomnography; CPAP = continuous positive airway pressure; t.i.d. = three times a day.
Fig 2. Consort diagram.
Fig 2. Consort diagram.
OSAS = sleep apnea syndrome; CPAP = continuous positive airway pressure.
Fig 3. Ultrasound imaging study at baseline…
Fig 3. Ultrasound imaging study at baseline and after treatment in the carbocysteine group.
(A)Flow-mediated dilation (FMD) of the brachial artery at baseline and after Carbocysteine of 1.5 g daily for 6 weeks in the obstructive sleep apnea group (n = 17; 8.38±4.95 vs. 10.06±5.78; P = 0.182). (B) Intima-media thickness (IMT) of the brachial artery at baseline and after Carbocysteine of 1.5g daily for 6 weeks in the obstructive sleep apnea group (n = 17; 0.71 ± 0.15 vs. 0.66 ± 0.15; P = 0.034)
Fig 4. Correlation between intima-media thickness (IMT)…
Fig 4. Correlation between intima-media thickness (IMT) and PSG Parameters in OSAS patients at baseline.
(A) Pearson correlation analysis between lowest oxygen saturation (LSaO2) and baseline IMT. (B) Spearman correlation analysis between Mean oxygen saturation (MSaO2) and baseline IMT. (C) Spearman correlation analysis between time percentage of 90% oxygen desaturation (T90%) and baseline IMT. (D) Spearman correlation analysis between nitric oxide (NO) and baseline IMT.

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