Pharmacotherapy for obstructive sleep apnea: targeting specific pathophysiological traits

The Present and Future of the Clinical Use of Physiological Traits for the Treatment of Patients with OSA: A Narrative Review

“…The purpose of the below section is to provide a context of how pharmacotherapy may affect the OSA traits, rather than a comprehensive review of pharmacotherapy in OSA; this can be found elsewhere [ 83 , 84 ]. Notably, most pharmacotherapy studies do not target individuals based on OSA traits, but use OSA severity cut-offs.…”

“…A more recent, larger ( n = 211), 4-week trial of atomoxetine and aroxybutynin showed a smaller but meaningful effect size (43% AHI reduction) [ 98 ]. Other combinations of noradrenergic-antimuscarinic therapies have been proposed and have undergone small trials, as nicely reviewed by Perger and colleagues [ 83 ]. They included reboxetine and oxybutynin, which demonstrated an improvement in UAMR and a 59% reduction in AHI scores at 1 week [ 99 ].…”

“…If P crit is sufficiently reduced to below −4 cm H 2 O, there is a resolution of respiratory events [ 106 ]. Pharmacologic agents that have been shown to reduce the AHI by targeting obesity include liraglutide, semaglutide, naltrexone/bupropion, and orlistat, and by targeting fluid shifts include furosemide and spironolactone [ 83 ].…”

ERS International Congress 2023: highlights from the Sleep Disordered Breathing Assembly

“…Some studies have focused on carbonic anhydrase inhibitors, such as acetazolamide that reduces events in both OSA and central sleep apnoea (CSA) patients [ 14 ] and sulthiame that reduces obstructive events in OSA without increasing blood pressure or heart rate [ 15 ]. In addition, the number of studies on drugs addressing poor muscle responsiveness during night has increased in recent years [ 16 ]. In particular, combinations of different noradrenergic and antimuscarinic drugs have been shown to be effective in reducing OSA severity (AHI) in some short-term trials (while other RCTs were negative) but with a slight increase in heart rate [ 17 – 19 ].…”