PT - JOURNAL ARTICLE AU - Davoud Eskandari AU - Ding Zou AU - Mahssa Karimi AU - Kaj Stenlöf AU - Ludger Grote AU - Jan Hedner TI - Zonisamide reduces obstructive sleep apnoea: a randomised placebo-controlled study AID - 10.1183/09031936.00158413 DP - 2014 Jan 01 TA - European Respiratory Journal PG - erj01584-2013 4099 - http://erj.ersjournals.com/content/early/2014/03/13/09031936.00158413.short 4100 - http://erj.ersjournals.com/content/early/2014/03/13/09031936.00158413.full AB - Carbonic anhydrase inhibition reduces apnoeic events in sleep disordered breathing. Zonisamide inhibits carbonic anhydrase, and induces weight loss in obese patients. This study explored the relative influence of these two properties, which may both alleviate obstructive sleep apnoea (OSA). Continuous positive airway pressure (CPAP) was used as a standard care comparator. 47 patients with moderate-to-severe OSA and a body mass index of 27–35 kg·m−2 were randomised to receive either zonisamide, placebo or CPAP for 4 weeks. The open extension phase (20 weeks) compared CPAP and zonisamide. Polysomnography, biochemistry and symptoms were evaluated. At 4 weeks, zonisamide reduced apnoea/hypopnoea index (AHI) by a mean±sd 33±39% and oxygen desaturation index by 28±31% (p = 0.02 and 0.014, respectively; placebo adjusted). The mean compliance adjusted reduction of AHI after zonisamide and CPAP was 13 and 61%, respectively, (p = 0.001) at 24 weeks. Body weight was marginally changed at 4 weeks, but reduced after zonisamide and increased after CPAP at 24 weeks (-2.7±3.0 kg versus 2.3±2.0 kg, p<0.001). Zonisamide decreased bicarbonate at 4 and 24 weeks. Side-effects were more common after zonisamide. Zonisamide reduced OSA independent of body weight potentially by mechanisms related to carbonic anhydrase inhibition. The effect was less pronounced than that obtained by CPAP. The carbonic anhydrase inhibitor zonisamide reduces sleep apnoea, but the effect is inferior to CPAP treatment http://ow.ly/tnmQ1