Pharmacological approaches to the treatment of obstructive sleep apnoea.
BACKGROUND
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.


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.
Kohler
Malcolm
M
University Hospital of Zurich, Sleep Disorders Centre and Pulmonary Division, Raemistrasse 100, Zurich 8091, Switzerland. Malcolm.K@bluewin.ch
Bloch
Konrad E
KE
Stradling
John R
JR
D000818:Animals; D002800:Cholinesterase Inhibitors / Q000494:pharmacology / Q000627:therapeutic use; D006801:Humans; D008803:Mianserin / Q000031:analogs & derivatives / Q000494:pharmacology / Q000627:therapeutic use; D000078785:Mirtazapine; D011530:Protriptyline / Q000494:pharmacology / Q000627:therapeutic use; D012123:Pulmonary Ventilation / Q000187:drug effects / Q000502:physiology; D016032:Randomized Controlled Trials as Topic / Q000379:methods; D020181:Sleep Apnea, Obstructive / Q000188:drug therapy* / Q000503:physiopathology; D016896:Treatment Outcome
D002800:Cholinesterase Inhibitors; D008803:Mianserin; D011530:Protriptyline; D000078785:Mirtazapine