Gabapentin acutely increases the apnea-hypopnea index in older men: data from a randomized, double-blind, placebo-controlled study

Although drugs with sedative properties may increase the risk of airway collapse during sleep, their acute effects on the apnea-hypopnea index in older adults are under-reported. We investigated the acute effects of gabapentin (GABA) on sleep breathing in older men without sleep apnea. A double-blind, randomized, placebo-controlled cross-over pilot study using a bedtime dose of gabapentin 300 mg was conducted in eight non-obese older men. Polysomnography measured the effects of the intervention. The apnea-hypopnea index was higher in the gabapentin arm than in the placebo arm (22.4 +/- 6.1 versus 12.2 +/- 4.3, P <= 0.05, d: 0.67), as was the oxygen desaturation index (20.6 +/- 5.8 versus 10.8 +/- 3.9, P <= 0.05, d: 0.68). The number needed to harm was four. A subset analysis demonstrated that differences in sleep respiratory parameters were present only during non-rapid eye movement sleep, as well as only in the supine position. No adverse events were reported. Hence, gabapentin worsened sleep breathing acutely compared with placebo. Long-term clinical trials are warranted to elucidate the clinical relevance of these findings for the safety profile of GABAergic agents.