PMC5078676_01
Values for AHI (panel A) and AI (panel B) are shown by night in monthly intervals before and after tamsulosin exposure ("off tamsulosin", blue dashes) and during tamsulosin exposure ("on tamsulosin", AHI solid red diamonds, AI solid red circles). The on-tamsulosin data points begin with the first dose of tamsulosin and, to accommodate the time needed to clear tamsulosin from the body, continue until four days after the final tamsulosin dose. As shown, both AHI and AI had been low and stable for months prior to the initiation of dosing with tamsulosin. Within two days after the first dose of tamsulosin, both AHI and AI exceeded values that had not been exceeded for months. Both AHI and AI reached apex values just before tamsulosin dosing was terminated specifically because of these changes and attendant symptoms. After termination of tamsulosin, AHI and AI declined over several days, returning to and then remaining at pre-tamsulosin levels (During the five calendar months shown in Fig. 1, the patient used CPAP for a total of 1064:06 h:min, for an average of 6 h 57 min per night, >4 h per night on 153 nights, <4 h per night on 0 nights.). (For interpretation of the references to color in this figure legend, the reader is referred to the web version of this article.)
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The patient's data for AHI and AI for the three months immediately prior to the tamsulosin dosing period, the period of tamsulosin dosing, and one month after discontinuation appear in Fig. 1. Notwithstanding this similarity, during the 119 off-tamsulosin days of Fig. 1 AI did not exceed 0.9. Phrased in another way, AI exceeded 0.9 on 0 of 119 days. (A review of historical data showed that AI had not exceeded 0.9 in more than 450 days.) During the on-tamsulosin days in Fig. 1B, AI exceeded the previous 18 months' maximum on 9 of 34 days.
The number of central events (panel A) and obstructive events (panel B) by night in monthly intervals before and after tamsulosin exposure ("off tamsulosin", blue dashes) and during tamsulosin exposure ("on tamsulosin", solid red diamonds [central events] or solid red circles [obstructive events]). The on-tamsulosin data points begin with the first dose of tamsulosin and, to accommodate the time needed to clear tamsulosin from the body, continue until four days after the final tamsulosin dose. The incidence of central events did not change with alpha1-adrenergic blockade while both the incidence and duration (not shown) of obstructive events increased markedly during tamsulosin exposure. (For interpretation of the references to color in this figure legend, the reader is referred to the web version of this article.)
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Detailed CPAP device data output (ResScan ) from 25 November 2015 after what proved to be the final dose of tamsulosin on the evening of 24 November 2015. Data collection began at 00:15 a.m. and ended at 06:39 a.m., a total of 6 h 24 min. Airway pressure was maintained at the machine maximum of 20 cm H2O (1.96 kPa*) for approximately 3h 20 min (52% of the total data collection time). Median leak rate for the night was 9.6 L/min. Leak exceeded 24 L/min for fewer than 20 min. AHI peaked at 23 events/h, almost entirely due to episodes of obstruction (red arrows), each obstructive event lasting 10-46 s, with the majority lasting 25 s or longer. Note that when the obstructive event rate was at its highest, between 04:15 and 06:39 a.m., the leak rate was near its lowest for the night. [*Multiply cm H2O by 0.098 to convert to kPa.].
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