Short-term Effects of Nortriptyline on Sleep Parameters for Residual OSA after UPPP

Document Type : Original

Authors

1 Otorhinolaryngology Research Center, Tehran University of Medical Sciences, Tehran, Iran.

2 ‏Otorhinolaryngology Research Center, Tehran University of Medical Sciences, Amir Alam Hospital, Tehran, Iran,

3 Otorhinolaryngology Research Center, Tehran University of Medical Sciences, Imam Khomeini Hospital, Tehran, Iran.

4 ‏Otorhinolaryngology Research Center, Tehran University of Medical Sciences, Imam Khomeini Hospital, Tehran, Iran.

5 Otorhinolaryngology Research Center, Tehran University of Medical Sciences, Amir Alam Hospital, Tehran, Iran,

10.22038/ijorl.2025.87813.3947

Abstract

Introduction:
Uvulopalatopharyngoplasty (UPPP) surgery, though helpful, may not always achieve optimal results for obstructive sleep apnea (OSA). This prospective, uncontrolled trial investigates the potential of nortriptyline in improving symptoms and sleep parameters in OSA patients who have previously undergone UPPP.
Materials and Methods:
This single-center study evaluated the effects of nortriptyline in 24 OSA patients who had undergone UPPP surgery one year prior. Participants underwent a type IV sleep study one night before starting nortriptyline, and one month after treatment. The study employed the Stanford Subjective Snoring Scale (SSSS) and the Epworth Sleepiness Scale (ESS) to evaluate subjective reports of snoring and daytime sleepiness.
Results:
The Apnea-Hypopnea Index (AHI) significantly decreased from 16.8 to 11.4 events/hour (p-value = 0.02, effect size = 0.5). Mean oxygen saturation significantly increased from 94.1% to 95.4% (p-value = 0.016, effect size = 0.6). Time spent below 90% oxygen saturation significantly decreased from 7.2% to 4.8% (p-value = 0.007, effect size = 0.73). ESS significantly decreased from 9.6 to 7.2 (p-value < 0.001, effect size = 0.89). SSSS significantly decreased from 7.1 to 3.1 (p-value = 0.002, effect size = 0.90).  Minor side effects were monitored; one participant developed excessive sleepiness, and another participant reported heart palpitations.
Conclusion:
This trial suggests that nortriptyline may be a promising treatment option for improving residual sleep apnea in patients who have already undergone UPPP but still experience symptoms. Further research is needed to confirm these initial results. Trial registration number: IRCT20230614058482N1
 

Keywords

Main Subjects

References

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Iranian Journal of Otorhinolaryngology
Volume 37, Issue 5
September and October 2025
Pages 233-240

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