IMAGES: Combined positive air way pressure and atomoxetine-oxybutynin for the treatment of severe obstructive sleep apnea

Obstructive sleep apnea is one of the most common sleep disorders. Positive airway pressure therapy is considered the gold standard for treating obstructive sleep apnea. Yet, optimal therapy might not be achieved in some cases of severe obstructive sleep apnea, despite using maximum settings. In this case report, we describe the successful combination of positive airway pressure therapy and atomoxetine-oxybutynin in reducing the apnea-hypopnea index from the severe range to the mild to moderate range. This was also associated with significant improvement in several symptoms including excessive daytime sleepiness and drowsiness while driving.