Pharmacological approaches to the treatment of obstructive sleep apnoea

Abstract

ChooseBackground: Currently the treatment of choice for symptomatic obstructive sleep apnoea (OSA) is continuous positive airway pressure (CPAP). Some patients with OSA do not tolerate CPAP or have insufficiently severe symptoms to justify its use; for these patients, drug therapy would be a desirable potential therapeutic alternative. Objective: To summarize the current evidence on the effectiveness of drug therapy in patients with OSA. Methods: A systematic review of randomized controlled trials was performed to investigate the effects of drug therapy on OSA. Results/conclusions: Searches of bibliographical databases revealed 33 trials investigating the effects of 27 different drugs on OSA severity and/or symptoms. The mechanisms by which these drugs are supposed to improve OSA include, amongst others, an increase in tone of the upper airways, an increase in ventilatory drive, a reduction in airway resistance, and alterations in surface tension forces in the upper airway. In most of these studies there was no significant effect on OSA observed. However, there is evidence from a few small trials that some drugs, especially those thought to increase upper airway muscle tone, have the potential to reduce OSA severity; but further data from larger studies of adequate duration are needed.

Comorbidities in interstitial lung diseases

“…Mood disorders and, especially, depression are common. Antidepressants have dual benefits in improving depression and reducing the severity of OSA [145,146]. The use of steroids in ILDs other than IPF can have impact on sleep leading to insomnia and multiple nocturnal wakening [147,148] as well as to central fat deposition in the neck region and deterioration of underlying OSA.…”

Mechanisms of vascular damage in obstructive sleep apnea

“…108 Given the damaging effects of osa on the vascular system, and the lack of alternative treatments, we should consider whether affected patients who do not tolerate CPaP should be more-aggressively treated with drugs that prevent the development of atherosclerosis or cardiovascular events, such as statins and/or antihypertensives (for example, β-blockers to counteract sympathetic activation), as prescribed for patients with diabetes mellitus. notably, however, many patients with osa would already be taking these drugs because of the high prevalence of cardiovascular comorbidities in these patients.…”

CPAP treatment in patients with idiopathic pulmonary fibrosis and obstructive sleep apnea—therapeutic difficulties and dilemmas

“…Antidepressant medications, such as selective serotonin receptor antagonists and mirtazapine are effective in reducing or even abolishing symptoms of mood disorders, and can improve sleep quality and consequently possible CPAP acceptance. Although they are still the subject of debate, some studies show that such medication might also improve the severity of OSA, as a result of a positive influence on upper airway respiratory muscle function, or by reducing REM sleep duration [14,15]. It remains to be determined whether such medication can be useful in the therapeutic approach to IPF patients.…”