Pharmacologic approaches for the management of symptoms and cardiovascular consequences of obstructive sleep apnea in adults.
BACKGROUND
Obstructive sleep apnea (OSA) is characterized by intermittent hypoxemia, arousals from sleep, and daytime sleepiness. Accumulating evidence indicates that hypoxemia and sleep disruption contribute to the development of cardiovascular abnormalities in OSA. OSA is effectively treated with continuous positive airway pressure (CPAP) therapy that splints open the airway during sleep. Studies have shown that CPAP therapy improves daytime sleepiness and attenuates cardiovascular abnormalities in patients with OSA. However, not all patients with OSA tolerate or adhere to CPAP therapy. Even patients who regularly use CPAP therapy may have a few hours each night exposed to the negative effects of untreated OSA. As a result, complementary pharmacologic therapies that can be used with CPAP therapy have the potential to reduce symptoms and consequences of OSA.


CONCLUSIONS
The wake-promoting medications modafinil and armodafinil effectively improve residual sleepiness in patients treated with CPAP therapy. Although results are equivocal so far, modafinil and armodafinil may also improve quality of life and global clinical condition in patients with OSA and residual sleepiness treated with CPAP therapy. Pharmacologic therapies also have the potential to be used with CPAP therapy to minimize cardiovascular perturbations and risk of cardiovascular disease. Preliminary studies suggest that inhibition of the enzyme xanthine oxidase and inhibition of sympathetic nervous system overactivity may have therapeutic potential to reduce cardiovascular harm in patients with OSA.


CONCLUSIONS
Future studies of pharmacologic therapies to reduce symptoms and cardiovascular consequences of OSA should be increasingly performed as our understanding of the mechanisms mediating the adverse effects of OSA continues to evolve.
Dopp
John M
JM
Pharmacy Practice Division, School of Pharmacy, University of Wisconsin, Madison, WI, USA. jmdopp@pharmacy.wisc.edu
Morgan
Barbara J
BJ
D001559:Benzhydryl Compounds / Q000009:adverse effects / Q000627:therapeutic use; D002318:Cardiovascular Diseases / Q000188:drug therapy* / Q000517:prevention & control / Q000523:psychology; D000697:Central Nervous System Stimulants / Q000009:adverse effects / Q000627:therapeutic use*; D003131:Combined Modality Therapy; D045422:Continuous Positive Airway Pressure / Q000523:psychology; D006970:Disorders of Excessive Somnolence / Q000188:drug therapy* / Q000517:prevention & control; D006993:Hypnotics and Sedatives / Q000627:therapeutic use; D000077408:Modafinil; D010349:Patient Compliance; D011725:Pyridines / Q000627:therapeutic use; D011788:Quality of Life / Q000523:psychology; D012084:Renin-Angiotensin System / Q000187:drug effects; D020181:Sleep Apnea, Obstructive / Q000150:complications / Q000188:drug therapy* / Q000523:psychology; D013565:Sympatholytics / Q000627:therapeutic use; D014969:Xanthine Oxidase / Q000037:antagonists & inhibitors; D000077334:Zolpidem
D001559:Benzhydryl Compounds; D000697:Central Nervous System Stimulants; D006993:Hypnotics and Sedatives; D011725:Pyridines; D013565:Sympatholytics; D000077334:Zolpidem; D014969:Xanthine Oxidase; D000077408:Modafinil