Combination Drug-Therapy for Patients With Untreated Obstructive Sleep Apnea

Exclusion Criteria

• •Pregnancy
• •Breastfeeding
• •Prisoners
• •Adherent with effective therapy for OSA
• •Other known untreated sleep fragmenting disorder, such as periodic limb movement disorder, or narcolepsy
• •Inability to sleep supine for overnight sleep studies
• •Circadian rhythm disorder
• •Unrevascularized coronary artery disease, angina, prior heart attack or stroke, congestive heart failure
• •Uncontrolled hypertension (systolic blood pressure \>160mmHg, diastolic blood pressure \>95mmHg)
• •Presence of tracheostomy
• •Hospitalization within the past 90 days
• •Prior peptic ulcer disease, esophageal varices, or gastrointestinal bleeding (\< 5 years)
• •Prior gastric bypass surgery
• •Chronic liver disease or end-stage kidney disease
• •Active illicit substance use or \>2 oz daily alcohol use (i.e. \>2 12 oz bottles of beers, \>2 5 oz glasses of wine, \>2 1.5 oz glasses of hard liquor such as spirits, gin, whiskey, etc.)
• •Psychiatric disease, other than well controlled depression/anxiety
• •Cognitive impairment, inability to provide consent, or inability to complete research procedures (e.g. questionnaires that are only available/validated in English)
• •Chronically using study drugs or drugs with similar pharmacodynamic effects (acetazolamide - carbonic anhydrase inhibitors, eszopiclone - benzodiazepine receptor agonists, venlafaxine - serotonin/norepinephrine reuptake inhibitors and other antidepressants)
• •Regular use of medications known to affect control of breathing (opioids, benzodiazepines, theophylline)
• •Contraindications to taking study drugs, including allergies to any of the drugs or sulfa allergy; concomitant use of antidepressants, opioids, sedatives/hypnotics, thiazide diuretics or angiotensin-receptor blockers; or severe nocturnal hypoxia (SpO2 nadir \<70% on diagnostic sleep study).