Medical therapy for obstructive sleep apnea: a review by the Medical Therapy for Obstructive Sleep Apnea Task Force of the Standards of Practice Committee of the American Academy of Sleep Medicine.
A significant number of patients with obstructive sleep apnea neither tolerate positive airway pressure (PAP) therapy nor achieve successful outcomes from either upper airway surgeries or use of an oral appliance. The purpose of this paper, therefore, was to systematically evaluate available peer-reviewed data on the effectiveness of adjunctive medical therapies and summarize findings from these studies. A review from 1985 to 2005 of the English literature reveals several practical findings. Weight loss has additional health benefits and should be routinely recommended to most overweight patients. Presently, there are no widely effective pharmacotherapies for individuals with sleep apnea, with the important exceptions of individuals with hypothyroidism or with acromegaly. Treating the underlying medical condition can have pronounced effects on the apnea/hypopnea index. Stimulant therapy leads to a small but statistically significant improvement in objective sleepiness. Nonetheless, residual sleepiness remains a significant health concern. Supplemental oxygen and positional therapy may benefit subsets of patients, but whether these therapies reduce morbidities as PAP therapy does will require rigorous randomized trials. PAP therapy has set the bar high for successful treatment of sleep apnea and its associated morbidities. Nonetheless, we should strive towards the development of universally effective pharmacotherapies for sleep apnea. To accomplish this, we require a greater knowledge of the neurochemical mechanisms underlying sleep apnea, and we must use this infrastructure of knowledge to design well-controlled, adequately powered studies that examine, not only effects on the apnea/hypopnea index, but also the effects of pharmacotherapies on all health related outcomes shown beneficial with PAP therapy.
Veasey
Sigrid C
SC
Center for Sleep Respiratory Neurobiology, University of Pennsylvania, 972 Maloney Building, 3600 Spruce Street, Philadelphia, PA 19104, USA. veasey@mail.med.upenn.edu
Guilleminault
Christian
C
Strohl
Kingman P
KP
Sanders
Mark H
MH
Ballard
Robert D
RD
Magalang
Ulysses J
UJ
D001559:Benzhydryl Compounds / Q000627:therapeutic use; D003131:Combined Modality Therapy; D045422:Continuous Positive Airway Pressure; D019317:Evidence-Based Medicine; D006801:Humans; D000077408:Modafinil; D010102:Oxygen Inhalation Therapy; D011187:Posture; D017410:Practice Guidelines as Topic; D011530:Protriptyline / Q000627:therapeutic use; D016032:Randomized Controlled Trials as Topic; D018490:Serotonin Agents / Q000627:therapeutic use; D020181:Sleep Apnea, Obstructive / Q000628:therapy*; D016896:Treatment Outcome; D015431:Weight Loss
D001559:Benzhydryl Compounds; D018490:Serotonin Agents; D011530:Protriptyline; D000077408:Modafinil