Angiotensin-converting enzyme (ACE) inhibitors may induce cough and rhinopharyngeal
inflammation. Obstructive sleep apnea (OSA) is characterized by upper airway inflammation.
We describe a patient who, during enalapril treatment, developed cough, upper airway
symptoms, and diurnal sleepiness, with an increased number of obstructive apnea-hypopnea
episodes (apnea-hypopnea index [AHI], 25) during sleep. Her symptoms and AHI improved
1 month after enalapril was discontinued and diuretic therapy (hydrochlorothiazide-spironolactone)
was initiated. Similar findings were observed in 4 other patients with OSA who had
ACE inhibitor-induced cough. The mean ± SD AHI was 33.8±21.0 during enalapril treatment
and 20.0±17.0 after withdrawal of this drug (P=.04). Exhaled nitric oxide, a marker of airway inflammation, was increased during
enalapril treatment (15.0±4.3 parts per billion) and decreased after discontinuation
of this drug (9.0±2.6; P=.03). No significant difference in the AHI and exhaled nitric oxide was observed
in 4 patients with OSA who did not experience cough, before or after withdrawal of
ACE inhibitor treatment. These findings suggest that ACE inhibitor treatment may contribute
to OSA by inducing upper airway inflammation.
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Article Info
Footnotes
This study was supported by grants from the Italian Ministry of Instruction, University and Research.
None of the authors has affiliations or financial involvement with any organization or entity with a financial interest in the subject matter discussed in the article.
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Copyright
© 2006 Mayo Foundation for Medical Education and Research. Published by Elsevier Inc. All rights reserved.
