Risks associated with use of stimulant medications in patients with obstructive sleep apnea and cardiomyopathy: a case-control study

Meghna P. Mansukhani, Bhanu Prakash Kolla, John G. Park

Research output: Contribution to journalArticlepeer-review

3 Scopus citations


Objectives Stimulant medications are indicated in patients with obstructive sleep apnea (OSA) who experience sleepiness despite optimal control of sleep-disordered breathing. The safety of stimulant medications in patients with OSA and co-morbid cardiomyopathy is unknown. We performed a case-control study to assess cardiovascular outcomes and mortality risk associated with stimulant use in this group of patients. Methods A total of 162 subjects with OSA and cardiomyopathy were identified. Subjects who used stimulant medications for ≥1 month were designated as cases. Age-and-sex-matched controls not taking these medications were randomly chosen from the same cohort. Outcomes assessed were mortality, implantable cardioverter-defibrillator (ICD) and pacemaker insertion. Results Twenty-two cases and 44 controls were included in the analyses. Mean age was 62.6 ± 15 years, 72% were male. Median duration of medication use was 27 months (range 1–98). There were four deaths among cases versus eight among controls. Four cases had a pacemaker and six had an ICD inserted, compared to six and eight respectively in the control group. Age (p = 0.01) and positive airway pressure (PAP) compliance (p = 0.01), but not stimulant medication use (p = 1.00) were associated with mortality on univariate analysis. In multiple logistic regression analyses accounting for body mass index, apnea–hypopnea index/respiratory disturbance index, PAP compliance, ejection fraction and duration of follow up, use of stimulant medication was not associated with mortality (p = 0.50), pacemaker (p = 0.20) or ICD (p = 0.90) implantation. Conclusions Stimulant medications were not associated with elevated risk of mortality, pacemaker or ICD implantation in this case-control study, even after accounting for multiple confounders.

Original languageEnglish (US)
Pages (from-to)171-175
Number of pages5
JournalSleep Medicine
StatePublished - Apr 1 2017


  • Central nervous system stimulant
  • Heart failure
  • Hypersomnia
  • Sleep disordered breathing
  • Somnolence
  • Wakefulness promoting agent

ASJC Scopus subject areas

  • General Medicine


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