Review: Pharmacotherapy of obstructive sleep apnea

Abstract

Obstructive sleep apnea (OSA) is associated with serious comorbid illnesses and diminished quality of life. At this time, continuous positive airway pressure (CPAP) therapy is the treatment of choice. However, only half of those individuals who accept CPAP are still using it at the end of one year. Furthermore, efficacy for improving self-reported sleepiness appears to be greater for patients with severe sleep apnea and severe sleepiness than other patient groups. Some patients, notwithstanding optimized therapy and therapeutic adherence continue experiencing excessive daytime somnolence. Consequently, other treatment modalities have developed, including oral appliances, surgery and pharmacotherapy. It is widely believed, albeit not empirically demonstrated, that an effective medication to treat OSA would elicit better acceptance and adherence than having to use a machine for many hours on a nightly basis. Nonetheless, paucity of data (i.e. lack of large-scale randomized controlled trials), variability of perceived and actual benefits, and adverse side-effects of the drugs thus far tested have prevented the use of pharmacotherapy until now. In this paper we review the outcome data from published trials designed to evaluate efficacy and safety of various medications proposed for treating obstructive sleep apnea.

Obstructive Sleep Apnoea: From pathogenesis to treatment: Current controversies and future directions

“…the sleeping period) with minimal side‐effects. There are several reviews of attempted pharmacotherapy for OSA, these highlight the lack of effectively reliable interventions 20,80–84 . Unfortunately, this literature also indicates that although the basic science research underpinning the field of sleep and breathing is growing, there are too many examples of premature clinical studies with small samples in unselected patients, with little sound physiological rationale for most of the agents being tested or their proposed targets 20,80–84 .…”

“…There are several reviews of attempted pharmacotherapy for OSA, these highlight the lack of effectively reliable interventions 20,80–84 . Unfortunately, this literature also indicates that although the basic science research underpinning the field of sleep and breathing is growing, there are too many examples of premature clinical studies with small samples in unselected patients, with little sound physiological rationale for most of the agents being tested or their proposed targets 20,80–84 . Even once potentially viable targets for pharmacotherapy are identified, however, barriers to efficacy are: (i) the agent not getting to the desired target sites to exert its beneficial effect (a delivery problem); (ii) the agent acting at other sites to obscure, or oppose, the beneficial response (specificity problem); (iii) efficacy being obscured by unwanted side‐effects (concentration‐dependent, receptor‐targeting and/or sensitivity problems); (iv) different responses occurring in rapid eye movement sleep versus non‐rapid eye movement sleep (a neurobiology problem); and (v) the actual sites of obstruction varying within and between patients across sleep states and body positions, 85 such that the pharmacotherapy may be effective at some times and not others.…”

A feasibility evaluation of oral pressure therapy for the treatment of obstructive sleep apnea

“…2008]. Pharmacotherapy has had a very limited role as a primary treatment of OSA [Jayaraman et al . 2008].…”

“…mandibular advancement devices) [Clark et al 1996;Ferguson et al 2006], and nasal appliances [Colrain et al 2008]. Pharmacotherapy has had a very limited role as a primary treatment of OSA [Jayaraman et al 2008]. Surgical treatment methods include radiofrequency and laser volumetric reduction of the soft palate and tongue, uvulopalatopharyngoplasy, palatal implants, maxillomandibular advancement, tongue suspension implants, and tracheotomy [Johnston et al 2002;Woodson, 2002;Kuhnel et al 2005].…”

New Developments in the Management of Chronic Obstructive Pulmonary Disease and the Overlap Syndrome

“…Termed "overlap OSAS/COPD" by these authors, the condition was defined as the coexistence of OSA and COPD. However, some differences should be noted between the characteristics of the patients in this study and the patients in Marin's study [7]. For inclusion in the Brazilian study, subjects were required to have a much higher AHI (≥15/h) than was required in the Spanish study (≥5/h).…”