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However, oxybutynin has shorter half\u2010life than atomoxetine and side effects that might discourage long\u2010term usage. Accordingly, we aimed to test the combination of atomoxetine and fesoterodine (Ato\u2010Feso), a newer anti\u2010muscarinic with extended release formulation, on OSA severity and endotypes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      Twelve subjects with OSA underwent a randomized, double\u2010blind, crossover trial comparing one night of atomoxetine plus fesoterodine (80\u20134\u2009mg) to placebo. Parameters of OSA severity (e.g., apnoea\u2013hypopnoea index [AHI], nadir oxygen desaturation and hypoxic burden) were calculated from two clinical, in\u2010lab polysomnographic studies. OSA endotypes (including collapsibility per V\n                      <jats:sub>MIN<\/jats:sub>\n                      and arousal threshold) were derived from validated algorithms.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Compared to placebo, Ato\u2010Feso did not reduce the AHI (34.2\u2009\u00b1\u200919.1 vs. 30.1\u2009\u00b1\u200928.2 events\/h,\n                      <jats:italic>p<\/jats:italic>\n                      \u00a0=\u00a00.493), but reduced the apnoea index (12.9 [28.8] vs. 1.8 [9.1] events\/h, median [interquartile range],\n                      <jats:italic>p<\/jats:italic>\n                      \u00a0=\u00a00.027) and increased nadir desaturation (76.8 [8.0] vs. 82.2 [8.8] %,\n                      <jats:italic>p<\/jats:italic>\n                      \u00a0=\u00a00.003); a non\u2010significant trend for improved hypoxic burden was observed (52.4 [50.5] vs. 29.7 [78.9] %min\/h,\n                      <jats:italic>p<\/jats:italic>\n                      \u00a0=\u00a00.093). Ato\u2010Feso lowered collapsibility (raised V\n                      <jats:sub>MIN<\/jats:sub>\n                      ; 43.7 [29.8\u201355.7] vs. 56.8 [43.8\u201369.8] %V\n                      <jats:sub>EUPNOEA<\/jats:sub>\n                      , mean [CI],\n                      <jats:italic>p<\/jats:italic>\n                      \u00a0=\u00a00.002), but reduced the arousal threshold (129.3 [120.1\u2013138.6] vs. 116.7 [107.5\u2013126] %V\n                      <jats:sub>EUPNOEA<\/jats:sub>\n                      ,\n                      <jats:italic>p<\/jats:italic>\n                      \u00a0=\u00a00.038). In post hoc analysis, 6\/6 patients with milder collapsibility (V\n                      <jats:sub>MIN<\/jats:sub>\n                      \u2009&gt;\u200943%) exhibited OSA resolution (drop in AHI\u2009&gt;\u200950% and residual AHI\u2009&lt;\u200910 events\/h) and improved hypoxaemia.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>While inefficacious in unselected patients, Ato\u2010Feso administered for one night suppressed OSA in patients with milder collapsibility. Ato\u2010Feso may hold some promise as an alternative OSA treatment in certain subgroups of individuals.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/resp.14326","type":"journal-article","created":{"date-parts":[[2022,7,11]],"date-time":"2022-07-11T00:04:11Z","timestamp":1657497851000},"page":"975-982","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":34,"title":["Atomoxetine and fesoterodine combination improves obstructive sleep apnoea severity in patients with milder upper airway collapsibility"],"prefix":"10.1111","volume":"27","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4142-9124","authenticated-orcid":false,"given":"Ludovico","family":"Messineo","sequence":"first","affiliation":[{"name":"Division of Sleep and Circadian Disorders, Departments of Medicine and Neurology Brigham &amp; Women's Hospital &amp; Harvard Medical School  Boston Massachusetts 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