The efficiency of azelastine hydrochloride and fluticasone propionate nasal spray to improve PAP adherence in patients with obstructive sleep apnea

Patients with obstructive sleep apnea (OSA) often struggle with CPAP therapy adherence. The intranasal corticosteroids (INS) alone have not significantly improved CPAP adherence but the combination drugs that faster relieved symptoms were not well studied. This study aimed to assess the combined effectiveness of INS (fluticasone propionate) and intranasal antihistamines (azelastine hydrochloride) in enhancing CPAP adherence and mitigating CPAP-induced rhinitis symptoms in OSA patients. A double-blind, randomized controlled trial with stratified random sampling was conducted at Thammasat University Hospital from March 2022 to March 2023. Participants included OSA patients undergoing CPAP treatment. The patients completed questionnaires and interviews at the baseline, the second week, and one month after starting CPAP therapy, with CPAP usage electronic data collected. Among 116 enrolled patients, most had severe OSA (78.9%), with a majority being male (56.9%). The intervention group did not significantly differ from the placebo group in terms of CPAP usage, nasal symptoms, quality of life, or side effects. Subgroup analysis showed improved CPAP adherence in the treatment group when using pressure below 15 cm H₂O (7.8% increase in CPAP usage days, P = 0.04). This study marks the first evaluation of combination drugs for enhancing CPAP therapy adherence in OSA patients. Although these drugs did not significantly enhance overall CPAP adherence, there was a trend toward increasing CPAP adherence in patients using lower pressure levels. Thus, combining fluticasone and azelastine may benefit certain OSA patients. Further research is essential to comprehend and validate these benefits fully.Clinicaltrials.in.th number TCTR20220308003 (08/03/2022).