Identifying Sleep Apnea Patients That Best Respond to Atomoxetine Plus Oxybutynin Therapy

Eligibility Criteria

• * Suspected or diagnosed OSA
• * Recent drug induced sleep endoscopy results available (performed as part of routine clinical care).
• * Any uncontrolled medical condition
• * Current use of the medications under investigation
• * Use of medications expected to stimulate or depress respiration (including opioids, barbiturates, doxapram, almitrine, theophylline, 4-hydroxybutanoic acid).
• * Current use of hypnotic medications (trazodone, eszopiclone, benzodiazepines).
• * Current use of SNRIs/SSRIs or anticholinergic medications.
• * Conditions likely to affect obstructive sleep apnea physiology: neuromuscular disease or other major neurological disorder, heart failure (also below), or any other unstable major medical condition.
• * Respiratory disorders other than sleep disordered breathing: chronic hypoventilation/hypoxemia (awake SaO2 \< 92% by oximetry) due to chronic obstructive pulmonary disease or other respiratory conditions.
• * Other sleep disorders: periodic limb movements, narcolepsy, or parasomnias.
• * Contraindications for atomoxetine and oxybutynin, including:
• * hypersensitivity to atomoxetine or oxybutynin (angioedema or urticaria)
• * pheochromocytoma
• * use of monoamine oxidase inhibitors
• * benign prostatic hypertrophy, urinary retention
• * untreated narrow angle glaucoma
• * bipolar disorder, mania, psychosis
• * history of major depressive disorder (age\<24).
• * history of attempted suicide or suicidal ideation within one year prior to screening
• * clinically significant constipation, gastric retention
• * pre-existing seizure disorders
• * clinically-significant kidney disorders (eGFR\<60 ml/min/1.73m2)
• * clinically-significant liver disorders
• * clinically-significant cardiovascular conditions
• * moderate-to-severe hypertension (SBP\>180 mmHg or DBP\>110 mmHg measured at baseline; average of evening and morning measures\*)
• * cardiomyopathy (LVEF\<50%) or heart failure
• * advanced atherosclerosis
• * history of cerebrovascular events
• * history of cardiac arrhythmias e.g., atrial fibrillation, QT prolongation
• * other serious cardiac conditions that would raise the consequences of an increase in blood pressure or heart rate
• * myasthenia gravis
• * Claustrophobia
• * Pregnancy or nursing