Medical Treatment of Obstructive Sleep Apnea

Abstract

A variety of treatment options are available for the treatment of obstructive sleep apnea in addition to positive pressure therapy and surgery. These modes of treatment might be employed in patients who cannot tolerate positive pressure therapy despite aggressive measures to improve compliance. These options include weight reduction, sleep hygiene, positional therapy, and oxygen therapy. Some of the options are still experimental and include pharyngeal muscle and hypoglossal nerve stimulators. A variety of pharmacological agents have also been used. The mechanisms by which these drugs improve sleep-disordered breathing include increasing ventilatory drive and upper airway muscle tone, reducing the amount of rapid eye movement (REM) sleep, and enhancing daytime wakefulness.

Ventilatory management of sleep-disordered breathing in children

“…In some cases, further craniofacial surgery may be an alternative treatment option [6]. Although weight loss may result in an improvement in OSAS [7], this is notoriously difficult to achieve. In any case, CPAP therapy is required until sufficient weight loss can occur.…”

Mechanisms contributing to the genesis of hypoglossal preinspiratory discharge

“…Though the precise mechanistic details may be beyond the scope of therapeutic relevance, if asphyxia causes progressive reduction of the inhibitory network circuitry and resuscitation involves the recovery of these elements, various drugs could enhance or strengthen inhibitory neurotransmission and recovery of normal triphasic eupnea following apneic episodes (Adén, 2011). Low dose respiratory stimulants, such as phosphodiesterase inhibitors, may putatively be useful in the treatment of sleep apnea (Qureshi and Lee-Chiong, 2005), sensitizing central chemoreceptors, increasing the duration and amplitude of the preinspiratory component of upper airway respiratory-related nerve discharge, enhancing excitatory drive to excitatory glutamatergic neurons and amplifying the amplitude of inspiratory nerve discharge, as well as GABAergic and glycinergic neurons, thus decreasing the risk of upper airway collapse and enhancing recovery from apneic episodes. The effects of chronic intermittent hypoxia may be extrapolated and generalized to further elucidate the pathophysiology of sleep apnea and the effects of hypoxia on neural respiratory circuitry.…”

Impactos do tratamento conservador nas manifestações clínicas da apneia obstrutiva do sono

“…11,12,18 Os dispositivos posicionais são medidas simples de utilidade pública que podem ser combinados ou não a outras opções de tratamento e também como escolha terapêutica aos intolerantes ao CPAP e pessoas de baixa renda. [21][22][23] O tratamento conservador são medidas de primeira linha recomendado como um complemento às opções de tratamentos com CPAP, aparelhos orais e cirúrgicos. 7…”