Drug Therapy in Obstructive Sleep Apnea

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Key points

  • Current, mainly mechanical, therapies in obstructive sleep apnea (OSA) are frequently hampered by limited compliance (continuous positive airway pressure) or efficacy (mandibular advancement devices).

  • 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.

  • Relevant experimental models of OSA are lacking, as sleep disordered breathing is a heterogeneous

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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    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.

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