Drug therapy for obstructive sleep apnoea in adults

Papworth Hospital NHS Foundation Trust, Papworth, England, United Kingdom
Cochrane database of systematic reviews (Online) (Impact Factor: 6.03). 02/2006; 2(2):CD003002. DOI: 10.1002/14651858.CD003002.pub2
Source: PubMed


Obstructive sleep apnoea (OSA) is caused by collapse of the upper airway. The mainstay of medical treatment is continuous positive airways pressure (CPAP) delivered through a mask during sleep. Drug therapy has been proposed for patients with mild OSA and those intolerant of CPAP. Many drugs have been tested as treatments for obstructive sleep apnoea (when breathing stops during sleep). Most have not been found to be effective. A few have been shown to reduce the number of apnoeic episodes during sleep but have not yet been shown to improve well-being during wakefulness. We searched and reviewed all randomised placebo controlled trials of drugs in adult patients with OSA . Most of the trials had methodological flaws. Of 21 drugs tested, eight had some impact on the severity of OSA (in terms of either markers of sleep quality or symptoms of sleepiness) although in most people changes were only modest. Physostigmine, Mirtazipine and nasal lubricant were only trialed on single night studies and the long-term effects are therefore unknown. Topical nasal steroid was tolerated, reduced the severity of sleep apnoea and improved subjective daytime alertness in a specific sub group with both OSA and rhinitis. Acetazolamide reduced the number of respiratory events per hour of sleep but did not reduce daytime sleepiness and was poorly tolerated long term. Paroxetine had only a small effect on the amount of OSA and while it was tolerated there was no useful effect on daytime symptoms. In contrast participants reported a symptomatic benefit from protriptyline, but there was no improvement in OSA suggesting a different mechanism for their improved sense of well-being.

2 Reads
  • Source
    • "The efficacy of CPAP in patients with milder forms of OSA is still unproven [14], which could be secondary to the low adherence in the use of the method. Other therapies could be beneficial in such patients [15]. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Obstructive sleep apnea (OSA) and hypertension are well-known cardiovascular risk factors. Their control could reduce the burden of heart disease across populations. Several drugs are used to control hypertension, but the only consistently effective treatment of OSA is continuous positive airway pressure. The identification of a drug capable of improving OSA and hypertension simultaneously would provide a novel approach in the treatment of both diseases.Methods/design: This is a randomized double-blind clinical trial, comparing the use of chlorthalidone with amiloride versus amlodipine as a first drug option in patients older than 40 years of age with stage I hypertension (140 to 159/90 to 99 mmHg) and moderate OSA (15 to 30 apneas/hour of sleep). The primary outcomes are the variation of the number of apneas per hour and blood pressure measured by ambulatory blood pressure monitoring. The secondary outcomes are adverse events, somnolence scale (Epworth), ventilatory parameters and C reactive protein levels. The follow-up will last 8 weeks. There will be 29 participants per group. The project has been approved by the ethics committee of our institution. The role of fluid retention in OSA has been known for several decades. The use of diuretics are well established in treating hypertension but have never been appropriately tested for sleep apnea. As well as testing the efficacy of these drugs, this study will help to understand the mechanisms that link hypertension and sleep apnea and their treatment.Trial registration: NCT01896661.
    Trials 01/2014; 15(1):1. DOI:10.1186/1745-6215-15-1 · 1.73 Impact Factor
  • Source
    • "Pharmacologic treatment for Obstructive Sleep Apnea (OSA) is limited (Smith et al., 2006), due to the complexity of the neurochemical control and neuromodulation of central respiratory drive and the upper airway motor output (Carley and Radulovacki, 2008). Nevertheless, the poor tolerance and long-term adherence to Continuous Positive Airway Pressure (CPAP) treatment in OSA (Weaver and Grunstein, 2008), make discovery of such therapeutic alternatives clinically relevant and important. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Study Objective: Animal data suggest that Δ(9)-TetraHydroCannabinol (Δ(9)THC) stabilizes autonomic output during sleep, reduces spontaneous sleep-disordered breathing, and blocks serotonin-induced exacerbation of sleep apnea. On this basis, we examined the safety, tolerability, and efficacy of dronabinol (Δ(9)THC), an exogenous Cannabinoid type 1 and type 2 (CB1 and CB2) receptor agonist in patients with Obstructive Sleep Apnea (OSA). Design and Setting: Proof of concept; single-center dose-escalation study of dronabinol. Participants: Seventeen adults with a baseline Apnea Hypopnea Index (AHI) ≥15/h. Baseline polysomnography (PSG) was performed after a 7-day washout of Continuous Positive Airway Pressure treatment. Intervention: Dronabinol was administered after baseline PSG, starting at 2.5 mg once daily. The dose was increased weekly, as tolerated, to 5 mg and finally to 10 mg once daily. Measurements and Results: Repeat PSG assessments were performed on nights 7, 14, and 21 of dronabinol treatment. Change in AHI (ΔAHI, mean ± SD) was significant from baseline to night 21 (-14.1 ± 17.5; p = 0.007). No degradation of sleep architecture or serious adverse events was noted. Conclusion: Dronabinol treatment is safe and well-tolerated in OSA patients at doses of 2.5-10 mg daily and significantly reduces AHI in the short-term. These findings should be confirmed in a larger study in order to identify sub-populations with OSA that may benefit from cannabimimetic pharmacologic therapy.
    Frontiers in Psychiatry 01/2013; 4:1. DOI:10.3389/fpsyt.2013.00001
  • Source
    • "However, insufficient evidence of those drugs in clinical trials restricts their use. Effective pharmacological therapies are still desirable (Magalang and Mador, 2003; Smith et al., 2006). More recently, there has been an emphasis on the importance of treating the underlying systemic inflammation and oxidative stress, in order to treat SDB. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Sleep-disordered breathing (SDB) is a prevalent affliction, which can range from simple snoring to severely obstructive sleep apnea. Compared to current treatment options of SDB, traditional Chinese medicine (TCM) provides a noninvasive way to relieve SDB-related symptoms and deaths. The purpose of this retrospective study was to observe the progression of adult SDB patients who had taken compound formula SZ + NUH (concentrated herbal granules) for four weeks. Depending on subjects' individual needs, minor additions of formulas or single herbs were allowed. We found a significant amount of relief from snoring among the 118 enrolled subjects, according to before-after scores observed through the Snore Outcome Survey (SOS). Furthermore, as projected from the moderate linear correlation in before-after scores, we inferred that those cases with more severe snoring at baseline had greater improvement after treatment. Excessive daytime sleepiness was also significantly improved according to the results of the Epworth Sleepiness Scale (ESS). Assessment, using the SF-36 (Taiwanese version) revealed possible benefits of SZ + NUH in improving multiple facets of subjects' quality of life. During treatment, no significant side effects occurred. In conclusion, the TCM compound formula based on SZ + NUH could be a safe and effective option for SDB treatment.
    The American Journal of Chinese Medicine 01/2012; 40(1):11-24. DOI:10.1142/S0192415X12500024 · 2.76 Impact Factor
Show more