The findings from a small study suggest that etanercept may be a useful treatment for the excessive daytime sleepiness that often occurs with obstructive sleep apnea. In fact, the decrease in sleepiness was greater than typically seen with continuous positive airway pressure, one of the standard treatments for this condition.
Obstructive sleep apnea is a disorder in which breathing stops for short periods during sleep. These breathing disruptions make for poor-quality sleep and daytime symptoms, such as drowsiness and concentration problems. Obstructive sleep apnea can also lead to serious health problems, such as high blood pressure and other cardiovascular disease due to low oxygen levels. Previous reports have shown that levels of tumor necrosis factor (TNF)-alpha and interleukin 6, proteins produced by the immune system that play key roles in inflammation, are elevated in obstructive sleep apnea patients. It is thought that they may influence the drowsiness that accompanies this condition. Therefore, the researchers speculated that treatment with etanercept, a TNF-alpha antagonist, which is sold under the brand name Enbrel, could potentially improve this symptom. Dr. A. N. Vgontzas, from Pennsylvania State University College of Medicine in Hershey, and colleagues assessed the sleep effects of etanercept therapy in eight obese men with obstructive sleep apnea. The subjects were treated with placebo, or “sugar pill,” for 3 weeks and then with etanercept for 3 weeks. The researchers’ findings appear in September issue of The Journal of Endocrinology and Metabolism. Treatment with etanercept produced a significant and dramatic decrease in sleepiness, the authors note. In addition, etanercept therapy was associated with a significant reduction in apnea episodes compared with placebo. Etanercept therapy was also tied to a significant drop in interleukin-6 levels These results indicate that “neutralizing TNF-alpha activity is associated with a significant reduction of objective sleepiness in obese patients with obstructive sleep apnea,” the authors conclude. (SOURCE: Reuters, The Journal of Clinical Endocrinology and Metabolism, Oct 2004.)