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Current, mainly mechanical, therapies in obstructive sleep apnea (OSA) are frequently hampered by limited compliance (continuous positive airway pressure) or efficacy (mandibular advancement devices).
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Previous attempts to identify a drug therapy in OSA, in order to overcome these limitations, have been unsuccessful; there is currently no available pharmacologic alternative in this condition.
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Relevant experimental models of OSA are lacking, as sleep disordered breathing is a heterogeneous
Drug Therapy in Obstructive Sleep Apnea
Section snippets
Key points
Overview
Obstructive sleep apnea (OSA) is a common condition that has turned out to provide a major challenge for physicians and the health care systems. This form of sleep disordered breathing is characterized by recurrent episodes of complete or partial obstruction of the upper airway, which causes periodic hypoxia and hypercapnia during sleep.1 OSA leads to not only transient cortical arousals and sleep fragmentation but also to increased oxidative stress, autonomic dysregulation, and hemodynamic
Specific pharmacologic strategies applied in obstructive sleep apnea
A substantial body of literature on drug therapies in OSA is available.6 As mentioned earlier, most of the trials in OSA are limited in size; but there are also larger studies that meet more stringent quality criteria. Most studies have addressed the direct interventional effects on sleep disordered breathing, whereas others focused the effects on OSA following treatment of associated conditions, such as obesity, arterial hypertension, or gastroesophageal reflux disease.
Reduction of Daytime Sleepiness in Sleep Disordered Breathing
Although most daytime somnolence in OSA is eliminated by conventional therapy, there is a subset of patients with residual daytime sleepiness. The exact size of this group remains unknown, but approximately 15% of patients may be affected. There have been several studies on the efficacy and usefulness of pharmacologic therapy addressing sleepiness in such patients.84 The analeptic modafinil, which is widely used for this indication, has multiple pharmacologic effects, including facilitation of
Summary
There is an unmet need for a drug therapy in OSA. However, previous attempts to identify an omnipotent drug have generally been unsuccessful; there is currently no available pharmacologic alternative to the mechanical therapies generally applied in this condition. Although the general efficacy of a medication may be lower than, for instance, that seen after CPAP, it should be recognized that a poorer efficacy in comparative terms may be overcome by better compliance. In fact, the poor long-term
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Cited by (15)
Turning Over a New Leaf—Pharmacologic Therapy in Obstructive Sleep Apnea
2022, Sleep Medicine ClinicsCitation Excerpt :Previous attempts to generate a drug therapy were more or less serendipity driven, and the literature in the area is characterized by small-scale explorative studies. These studies have been reviewed in several publications in the area as well as in a Cochrane review.6–8 There are now better-designed trials, which adequately address many of the potential pitfalls encountered in previous studies, under way.
Combined noradrenergic plus antimuscarinic agents for obstructive sleep apnea - A systematic review and meta-analysis of randomized controlled trials
2022, Sleep Medicine ReviewsCitation Excerpt :Several different pharmacological therapies for OSA have been evaluated, including drugs that act by increasing airway muscle tone and ventilatory drive or raising the arousal threshold [8]. Although some antidepressant medications such as selective serotonin/noradrenaline reuptake inhibitors (venlafaxine, paroxetine and fluoxetine) may have value in the management of OSA [6], there is currently insufficient evidence to recommend any specific drug [8,9]. Reduced pharyngeal muscle tone during sleep is a critical component of OSA that can be explained by the progressive withdrawal of specific monoamines (serotonin, histamine, orexin, norepinephrine) in the brainstem and noradrenergic input to the upper airway musculature [10].
Drug therapy for obstructive sleep apnea: From pump to pill?
2019, Sleep Medicine ReviewsThe firstly visited department affects the acceptance of CPAP in patients with obstructive sleep apnea: a cohort study
2023, Journal of Otolaryngology - Head and Neck SurgeryMeta-analysis of the Prediction Model of Obstructive Sleep Apnea Based on Image Fusion Algorithm
2023, Lecture Notes on Data Engineering and Communications Technologies
Disclosure Statement: Dr J. Hedner reports grants from the Swedish Heart-Lung Foundation and from the University of Gothenburg, grants from ResMed and from PhilipsRespironics related to European database work (ESADA), and personal fees from Itamar and AstraZeneca outside the submitted work. Dr J. Hedner has 2 patents related to OSA therapy, one pending and one issued. Dr D. Zou reports no conflicts of interest.