Sleep apnea medical therapy
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Saarah T. Alkhairy, M.D.
Overview
If left untreated, sleep apnea can have serious and life-threatening consequences such heart disease, hypertension, automobile accidents due to somnolence, and many other ailments. Treatment often starts with behavioral therapy. Medical treatment involves the treatment of the underlying cause and somnolence. Medications, such as acetazolamide and oxygen are not routinely used for the treatment of sleep apnea. The most effective treatments help open the airway such as continuous positive airway pressure (CPAP) and oral appliances.
Benefits of treatment
It is not clear that CPAP reduces hypertension and cardiovascular events; however, the lack of benefit may be partly due to noncompliance with therapy[1]
One trial found that treatment may lower blood pressure by about 3 - 5 mm Hg.[2][3]
Sleep Apnea Medical Therapy
The treatment often starts with behavioral therapy. Many patients are told to lose weight and avoid alcohol, sleeping pills, and other sedatives. These can relax throat muscles that contribute to the collapse of the airway at night.
Possibly owing to changes in pulmonary oxygen stores, sleeping on one's side (as opposed to on one's back) has been found to be helpful for central sleep apnea with Cheyne-Stokes respiration.[4]
Continuous positive airway pressure
For moderate to severe sleep apnea, CPAP therapy is extremely effective in reducing apneas and less expensive than other treatments. It splints the patient's airway open during sleep by means of a flow of pressurized air into the throat. The patient typically wears a plastic facial mask, which is connected by a flexible tube to a small bedside CPAP machine[5]. The CPAP machine generates the required air pressure to keep the patient's airways open during sleep.
There may be low compliance because patients find it uncomfortable[6]. One way to ensure CPAP therapy remains comfortable for patients is to ensure the CPAP face mask fits well. Eszopiclone, a sedative, used nightly for 14 nights may provide sustained increase in the patient's compliance[7]
Oral appliances
Mandibular advancement devices (MADs) are custom-made, oral appliance placed by general dentists that shifts the lower jaw forward and opens the bite slightly, which opens up the airway
Regarding oral appliances (mandibular advancement device (MAD)), "CPAP appears to be more effective in improving sleep disordered breathing than OA. The difference in symptomatic response between these two treatments is not significant, although it is not possible to exclude an effect in favour of either therapy. Until there is more definitive evidence on the effectiveness of OA in relation to CPAP, with regard to symptoms and long-term complications, it would appear to be appropriate to recommend OA therapy to patients with mild symptomatic OSAH, and those patients who are unwilling or unable to tolerate CPAP therapy" according to the Cochrane Collaboration.[8]
More recent randomized controlled trials report:
- Similar findings in that oral appliances (mandibular advancement device (MAD)) are easier to tolerate, but CPAP is reduces the apnea-hypopnea index (AHI) more. Quality-of-life indicators may be better with appliance.[9]
- MAD may not affect quality of life or daytime sleepiness, though other benefits may occur, among patients with apnea-hypopnea index (AHI) lower than 30.[10]
Pharmacological Agents
- Medications to treat any underlying causes
- Medications to treat somnolence
- Modafinil 200-400 mg per day
- Acetazolamide, medroxyprogesterone, fluoxetine, and protriptyline are ventilatory stimulants that are not routinely used[11]
Oxygen Therapy
- Low doses are used as a treatment for hypoxia but are discouraged due to side effects such as a dry or bloody nose, skin irritation from the nasal cannula or face mask, fatigue, and morning headaches[12][13]
References
- ↑ Barbé F, Durán-Cantolla J, Sánchez-de-la-Torre M; et al. (2012). "Effect of continuous positive airway pressure on the incidence of hypertension and cardiovascular events in nonsleepy patients with obstructive sleep apnea: a randomized controlled trial". JAMA. 307 (20): 2161–8. doi:10.1001/jama.2012.4366. PMID 22618923. Unknown parameter
|month=ignored (help) - ↑ Martínez-García M, Capote F, Campos-Rodríguez F, et al. Effect of CPAP on Blood Pressure in Patients With Obstructive Sleep Apnea and Resistant Hypertension: The HIPARCO Randomized Clinical Trial. JAMA. 2013;310(22):2407-2415. doi:10.1001/jama.2013.281250.
- ↑ Pedrosa RP, Drager LF, de Paula LK, Amaro AC, Bortolotto LA, Lorenzi-Filho G (2013). "Effects of OSA Treatment on BP in Patients With Resistant Hypertension: A Randomized Trial". Chest. 144 (5): 1487–94. doi:10.1378/chest.13-0085. PMID 23598607.
- ↑ Szollosi I, Roebuck T, Thompson B, Naughton MT (2006). "Lateral sleeping position reduces severity of central sleep apnea / Cheyne-Stokes respiration". Sleep. 29 (8): 1045–51. PMID pmid16944673 Check
|pmid=value (help). - ↑ General Information about Sleep Apnea Machines
- ↑ Hsu AA, Lo C (2003). "Continuous positive airway pressure therapy in sleep apnoea". Respirology. 8 (4): 447–54. doi:10.1046/j.1440-1843.2003.00494.x. PMID 14708553. Unknown parameter
|month=ignored (help) - ↑ Lettieri CJ, Shah AA, Holley AB, Kelly WF, Chang AS, Roop SA; et al. (2009). "Effects of a short course of eszopiclone on continuous positive airway pressure adherence: a randomized trial". Ann Intern Med. 151 (10): 696–702. doi:10.1059/0003-4819-151-10-200911170-00006. PMID 19920270.
- ↑ Lim J, Lasserson TJ, Fleetham J, Wright J (2006). "Oral appliances for obstructive sleep apnoea". Cochrane Database Syst Rev (1): CD004435. doi:10.1002/14651858.CD004435.pub3. PMID 16437488.
- ↑ Phillips CL, Grunstein RR, Darendeliler MA, Mihailidou AS, Srinivasan VK, Yee BJ; et al. (2013). "Health outcomes of continuous positive airway pressure versus oral appliance treatment for obstructive sleep apnea: a randomized controlled trial". Am J Respir Crit Care Med. 187 (8): 879–87. doi:10.1164/rccm.201212-2223OC. PMID 23413266.
- ↑ Marklund M, Carlberg B, Forsgren L, Olsson T, Stenlund H, Franklin KA (2015). "Oral Appliance Therapy in Patients With Daytime Sleepiness and Snoring or Mild to Moderate Sleep Apnea: A Randomized Clinical Trial". JAMA Intern Med. 175 (8): 1278–85. doi:10.1001/jamainternmed.2015.2051. PMID 26030264.
- ↑ Hudgel, David W.; Thanakitcharu, Sitthep (1998). "Pharmacologic Treatment of Sleep-disordered Breathing". American Journal of Respiratory and Critical Care Medicine. 158 (3): 691–699. doi:10.1164/ajrccm.158.3.9802019. ISSN 1073-449X.
- ↑ Mayos M, Hernández Plaza L, Farré A, Mota S, Sanchis J (2001). "[The effect of nocturnal oxygen therapy in patients with sleep apnea syndrome and chronic airflow limitation]". Archivos de Bronconeumología (in Spanish). 37 (2): 65–8. PMID 11181239. Unknown parameter
|month=ignored (help) - ↑ Breitenbücher A, Keller-Wossidlo H, Keller R (1989). "[Transtracheal oxygen therapy in obstructive sleep apnea syndrome]". Schweizerische Medizinische Wochenschrift (in German). 119 (46): 1638–41. PMID 2609134. Unknown parameter
|month=ignored (help)