To the Editor: Characterized by a symptom profile that includes snoring, excessive daytime somnolence, and reports of respiratory arrests during sleep, obstructive sleep apnea affects approximately 2% of the 30- to 60-year-old male population (1). It is believed that between 7 and 18 million North Americans could be afflicted with the disease. The most studied forms of treatment include surgery on the upper airway, intraoral-mandibular advancement devices, and long-term treatment with nasal continuous-positive-airway pressure (2). These treatments are cumbersome and expensive. Several pharmacologic treatments have been proposed, but we know of no widely used drug of reference.

Topiramate is a broad-spectrum antiepileptic and neurotherapeutic agent that may be used in treating several neurologic, psychiatric, and metabolic conditions, such as migraine and other forms of headache, bipolar disorder, eating disorders, and obesity. Topiramate has shown side effects, such as somnolence, cognitive impairment, and paresthesias. This report concerns a patient who suffered from bipolar disorder and obstructive sleep apnea who was successfully treated with the addition of topiramate to his previous medication regimen.

In view of its excellent tolerability, which leads to high compliance, and its excellent clinical results, topiramate should be seen as a promising pharmacological option for the treatment of obstructive sleep apnea and snoring. More in-depth, controlled studies with a larger number of patients are warranted.