title: Antioxidant Carbocysteine Treatment in Obstructive Sleep Apnea Syndrome: A Randomized Clinical Trial.
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.
  
  
  BACKGROUND
  ClinicalTrials.gov NCT02015598.
authors: Guangzhou Institute of Respiratory Disease, State Key Laboratory of Respiratory Diseases, The 1st Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China.
authors: Kang
authors: K
authors: Wu
authors: Guangzhou Institute of Respiratory Disease, State Key Laboratory of Respiratory Diseases, The 1st Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China.
authors: Xiaofen
authors: X
authors: Su
authors: Guangzhou Institute of Respiratory Disease, State Key Laboratory of Respiratory Diseases, The 1st Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China.
authors: Guihua
authors: G
authors: Li
authors: Guangzhou Institute of Respiratory Disease, State Key Laboratory of Respiratory Diseases, The 1st Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China.
authors: Nuofu
authors: N
authors: Zhang
mesh_terms: D000328:Adult; D000975:Antioxidants / Q000627:therapeutic use*; D002233:Carbocysteine / Q000627:therapeutic use*; D059168:Carotid Intima-Media Thickness; D045422:Continuous Positive Airway Pressure; D019332:Endothelin-1 / Q000097:blood; D006801:Humans; D008297:Male; D008315:Malondialdehyde / Q000097:blood; D008875:Middle Aged; D009569:Nitric Oxide / Q000097:blood; D010100:Oxygen / Q000097:blood; D017286:Polysomnography; D020181:Sleep Apnea, Obstructive / Q000175:diagnosis / Q000188:drug therapy*; D012913:Snoring / Q000188:drug therapy; D013482:Superoxide Dismutase / Q000097:blood
chemical_list: D000975:Antioxidants; D019332:Endothelin-1; D009569:Nitric Oxide; D008315:Malondialdehyde; D002233:Carbocysteine; D013482:Superoxide Dismutase; D010100:Oxygen