Short-term effects of oral theophylline in addition to CPAP in mild to moderate OSAS

Orth, M.; Grootoonk, Sandra; Duchna, Hans‐Werner; Zeeuw, Justus de; Walther, Jörg; Bauer, Torsten T.; Schultze‐Werninghaus, G.; Rasche, Kurt

doi:10.1016/j.rmed.2004.09.010

Cited by 24 publications

(20 citation statements)

References 15 publications

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“…Twenty-two studies met the eligibility criteria 11-32 ; however, 6 studies were excluded 27-32 : 4 represented duplicate reports from the same or related samples, and 2 had inappropriate control groups (1 treated with theophylline and the other, atrial overdrive pacing). 28,31 We included a total of 16 trials representing data from 818 participants. [11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26] Data Abstraction…”

Section: Study Selectionmentioning

confidence: 99%

Effect of Nocturnal Nasal Continuous Positive Airway Pressure on Blood Pressure in Obstructive Sleep Apnea

et al. 2007

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Abstract-Obstructive sleep apnea (OSA) is a very common risk factor for hypertension, and continuous positive airway pressure (CPAP) has been widely used to treat OSA. We conducted a meta-analysis of randomized, controlled trials to evaluate the effects of CPAP on blood pressure, reported as either a primary or secondary end point, among patients with OSA. Studies were retrieved by searching Medline (January 1980 to July 2006), the Cochrane Database of Systematic Reviews, conference abstracts, and bibliographies of review and original articles. From 255 relevant reports, 16 randomized clinical trials were selected that compared CPAP to control among participants with OSA, had a minimum treatment duration of 2 weeks, and reported blood pressure changes during the intervention or control period. Data on sample size, participant characteristics, study design, intervention methods, duration, and treatment results were independently abstracted by 2 investigators using a standardized protocol. Data from 16 trials representing 818 participants were examined using a random-effects model. Key Words: continuous positive airway pressure Ⅲ meta-analysis Ⅲ randomized, controlled trial Ⅲ sleep apnea syndromes Ⅲ blood pressure H ypertension is an important public health challenge worldwide. Its high prevalence and subsequent increased risk for developing cardiovascular diseases including heart attack, stroke, and chronic kidney disease have placed it as the leading risk factor for all-cause mortality and a major cause of life years-adjusted disability. 1 A recent study on the global burden of hypertension found that 26.4% of the adult population in 2000 had hypertension, and 29.2% were projected to have hypertension by the year 2025. This translates to Ϸ972 million persons, 333 million in economically developed countries and 639 million in economically developing countries, with hypertension in 2000. In 2025, 1.56 billion adults are expected to have hypertension. 2 Obstructive sleep apnea (OSA) is a very common risk factor for hypertension. In 2003, the Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation and Treatment of High Blood Pressure recognized sleep apnea as a common and identifiable cause of hypertension and suggested blood pressure (BP) screening among patients with OSA. 3 Although the prevalence varies by population and age group, it has been estimated that OSA affects Ϸ24% of middle aged men and 9% of middle-aged women. 4 In addition, the 5-year incidence was recently estimated to be 16% for mild-to-moderate and 7.5% for severe forms of OSA in the adult population. 5 Given the prevalence of OSA and its deleterious consequences, randomized, controlled trials have evaluated the use of continuous positive airway pressure (CPAP) to reduce BP among persons with OSA. Unfortunately, many of these trials were small in sample size and did not have sufficient statistical power to detect a modest but potentially important reduction in BP. We conducted a meta-analysis of randomized, controlled t...

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Section: Study Selectionmentioning

confidence: 99%

Effect of Nocturnal Nasal Continuous Positive Airway Pressure on Blood Pressure in Obstructive Sleep Apnea

et al. 2007

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“…They saw neither an improvement in AHI nor a reduction in positive pressure requirements. In contrast, they noticed a theophylline-related reduction in total sleep time and sleep efficiency [Orth et al 2005]. Overall, the utility of theophylline for reducing or treating OSA is marginal and lacks consistency.…”

Section: Ventilatory Stimulantsmentioning

confidence: 98%

Review: Pharmacotherapy of obstructive sleep apnea

Jayaraman

Sharafkhaneh

Hirshkowitz

et al. 2008

Ther Adv Respir Dis

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Obstructive sleep apnea (OSA) is associated with serious comorbid illnesses and diminished quality of life. At this time, continuous positive airway pressure (CPAP) therapy is the treatment of choice. However, only half of those individuals who accept CPAP are still using it at the end of one year. Furthermore, efficacy for improving self-reported sleepiness appears to be greater for patients with severe sleep apnea and severe sleepiness than other patient groups. Some patients, notwithstanding optimized therapy and therapeutic adherence continue experiencing excessive daytime somnolence. Consequently, other treatment modalities have developed, including oral appliances, surgery and pharmacotherapy. It is widely believed, albeit not empirically demonstrated, that an effective medication to treat OSA would elicit better acceptance and adherence than having to use a machine for many hours on a nightly basis. Nonetheless, paucity of data (i.e. lack of large-scale randomized controlled trials), variability of perceived and actual benefits, and adverse side-effects of the drugs thus far tested have prevented the use of pharmacotherapy until now. In this paper we review the outcome data from published trials designed to evaluate efficacy and safety of various medications proposed for treating obstructive sleep apnea.

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“…Molti di loro, infatti, potrebbero non avere mai avuto un incidente stradale. Essendo quindi necessario definire il livello di gravità della malattia, è compito del Medico di famiglia e del Medico del lavoro/Medico competente identificare soprattutto i pazienti ad alto rischio, quelli con chiari sintomi clinici, ovvero con grave sonnolenza diurna, con storia di frequenti incidenti stradali, con un punteggio della Epworth Sleepiness Scale compreso nell'intervallo [16][17][18][19][20][21][22][23][24]. Questi pazienti dovrebbero essere inviati in un centro per i disturbi del sonno, soprattutto quando si tratta di autisti di professione.…”

Section: Il Medico DI Medicina Generale E Le Osasunclassified

“…La somministrazione orale di teofillina (una sostanza appartenente al gruppo delle xantine, come la caffeina), ancora usata, seppur più raramente, per i suoi effetti broncodilatatori in malattie broncostruttive come asma e broncopneumopatia cronica ostruttiva (BPCO), può ridurre il numero di episodi di apnea, ma può anche produrre effetti collaterali come palpitazioni e insonnia. Di solito la teofillina è inefficace negli adulti con OSAS: è stata studiata in associazione alla CPAP nel trattamento delle apnee centrali del sonno con risultati non sicuramente efficaci [16].…”

Section: Il Medico DI Medicina Generale E Le Osasunclassified

[Management of Adult Obstructive Sleep Apnea Syndrome in General Practice: a new model of risk prevention]

Bruschelli

Bettoncelli

Monti

2017

CMI

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31documento si evidenzia come il settore delle cure primarie rivesta particolare importanza per le malattie respiratorie croniche, poiché la maggior parte delle consultazioni per questi problemi avviene proprio nel contesto della Medicina Generale. Un potenziamento dell'assistenza multiprofessionale integrata per queste patologie rappresenta una delle possibili soluzioni individuate dal Servizio Sanitario, poiché un'adeguata assistenza sul territorio al paziente con malattie respiratorie può ridurre le esacerbazioni e i ricoveri ospedalieri e incidere in modo decisivo sulla storia naturale delle malattie [3]. Inoltre, quando il ricovero si rende necessario, un buon coordinamento tra Medicina Generale e Specialistica ospedaliera può mettere in atto accessi e dimissioni protette, in grado di ridurre sensibilmente i tempi di degenza. Protagonista principale di questa assistenza è il Medico di Medicina Generale che oggi, IntroduzIoneNegli ultimi dieci anni la rilevanza epidemiologica in termini di morbilità e mortalità correlata alle malattie respiratorie ha sempre più coinvolto la Medicina del territorio e in particolare la Medicina di famiglia nell'identificazione di interventi efficaci di appropriatezza prescrittiva e di clinical governance [1]. In tale ambito si colloca l'attività svolta dalla GARD-Italia (Global Alliance against Chronic Respiratory Diseases-Italia), promossa presso il Ministero della Salute per discutere e promuovere iniziative relative alla salute respiratoria. In tale campo nel 2013 è stato prodotto il volume "La formazione nell'ambito delle malattie respiratorie: il punto di vista del Medico di Medicina Generale", elaborato con l'obiettivo di dare una prima strutturazione al tema della diagnosi precoce delle patologie respiratorie [2]. Nel Corresponding authorGermano Bettoncelli gerbet@alice.it Disclosure GB dichiara di aver ricevuto fee da GlaxoSmithKline e Chiesi Farmaceutici non correlati al presente articolo. CB e GCM dichiarano di non avere conflitti di interesse di natura finanziaria in merito ai temi trattati nel presente articolo Gestione clinica AbstractObstructive Sleep Apnea Syndrome is a condition characterized by paused breathing during sleep due to complete or partial obstruction of the upper airways. It is still underdiagnosed and underestimated, despite its respiratory, cardiovascular, and neurocognitive complications. Polysomnography is the gold standard for diagnosis. The treatment protocol, that has to be agreed with the patient, is behavioral, ventilator, and sometimes surgical. The role of general practitioners is essential for early identification of patients with high probability of OSAS. Physicians are supported by specific instruments of general practice, such as continuity of care, computerized medical records for oriented problems, medical history, and diagnostic-therapeutic methodology for an exclusive management model. Among their duties, there is also the management of care priorities for patients' comorbidities.

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Short-term effects of oral theophylline in addition to CPAP in mild to moderate OSAS

Cited by 24 publications

References 15 publications

Effect of Nocturnal Nasal Continuous Positive Airway Pressure on Blood Pressure in Obstructive Sleep Apnea

Effect of Nocturnal Nasal Continuous Positive Airway Pressure on Blood Pressure in Obstructive Sleep Apnea

Review: Pharmacotherapy of obstructive sleep apnea

[Management of Adult Obstructive Sleep Apnea Syndrome in General Practice: a new model of risk prevention]

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