Pharmacologic treatment of sleep-disordered breathing.
Available literature on the use of pharmacologic agents for the treatment of sleep-disordered breathing was reviewed by evidenced-based methodology. Evidence tables were created and studies were graded according to study design and the number of subjects included. Scores for each group of studies evaluating each pharmacologic agent were established so that the quality of research for different drugs could be compared. The use of various ventilatory stimulants, psychotropic drugs, and antihypertensive agents were reviewed. The most objective data are available on theophylline and opioid antagonist/nicotine groups. Although more controlled studies would be helpful, relatively clear-cut indications for the use of ventilatory stimulants exist for hypercapnic obesity-hypoventilation patients (medroxyprogesterone), myxedema (thyroid replacement), central apnea (acetazolamide), and periodic breathing in congestive heart failure (theophylline). Few randomized, well-controlled trials have been published that evaluate pharmacologic agents in the treatment of classic OSA. To date, no one agent stands out as being useful for OSA. Future research will need to characterize subjects so that various subsets of patients can be tried on one or on a combination of various pharmacologic agents.
Hudgel
D W
DW
Case Western Reserve University, Cleveland, Ohio; and Mahidol University, Ramathibodi Hospital, Bangkok, Thailand.
Thanakitcharu
S
S
D000086:Acetazolamide / Q000627:therapeutic use; D000959:Antihypertensive Agents / Q000627:therapeutic use; D001049:Apnea / Q000188:drug therapy; D001993:Bronchodilator Agents / Q000627:therapeutic use; D004232:Diuretics / Q000627:therapeutic use; D004417:Dyspnea / Q000188:drug therapy; D019317:Evidence-Based Medicine; D005260:Female; D006333:Heart Failure / Q000150:complications; D006801:Humans; D006935:Hypercapnia / Q000188:drug therapy; D007040:Hypoventilation / Q000188:drug therapy; D008297:Male; D008525:Medroxyprogesterone / Q000627:therapeutic use; D009230:Myxedema / Q000188:drug therapy; D009292:Narcotic Antagonists / Q000627:therapeutic use; D009538:Nicotine / Q000627:therapeutic use; D018722:Nicotinic Agonists / Q000627:therapeutic use; D009765:Obesity / Q000150:complications; D045167:Progesterone Congeners / Q000627:therapeutic use; D011619:Psychotropic Drugs / Q000627:therapeutic use; D016032:Randomized Controlled Trials as Topic; D012107:Research Design; D019141:Respiratory System Agents / Q000627:therapeutic use; D012891:Sleep Apnea Syndromes / Q000188:drug therapy*; D013806:Theophylline / Q000627:therapeutic use; D013963:Thyroid Hormones / Q000627:therapeutic use
D000959:Antihypertensive Agents; D001993:Bronchodilator Agents; D004232:Diuretics; D009292:Narcotic Antagonists; D018722:Nicotinic Agonists; D045167:Progesterone Congeners; D011619:Psychotropic Drugs; D019141:Respiratory System Agents; D013963:Thyroid Hormones; D009538:Nicotine; D013806:Theophylline; D008525:Medroxyprogesterone; D000086:Acetazolamide