Sleep apnea medical therapy: Difference between revisions
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==Overview== | ==Overview== | ||
If left untreated, sleep apnea can have serious and life threatening consequences | If left untreated, sleep apnea can have serious and life-threatening consequences such [[heart disease]], [[hypertension]], automobile accidents due to excessive daytime sleepiness, and many other ailments. Treatment often starts with [[behavioral therapy]]. Medical treatment involves treating the underlying cause and day-time sleepiness. 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. | ||
==Sleep Apnea Medical Therapy== | ==Sleep Apnea Medical Therapy== | ||
The treatment often starts with [[behavioral therapy]]. Many patients are told to avoid [[alcohol]], sleeping pills, and other [[sedatives]], which can relax throat muscles, contributing to the collapse of the airway at night. | The treatment often starts with [[behavioral therapy]]. Many patients are told to avoid [[alcohol]], sleeping pills, and other [[sedatives]], which can relax throat muscles, contributing 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]].<ref name="pmidpmid16944673">{{cite journal| author=Szollosi I, Roebuck T, Thompson B, Naughton MT| title=Lateral sleeping position reduces severity of central sleep apnea / Cheyne-Stokes respiration. | journal=Sleep | year= 2006 | volume= 29 | issue= 8 | pages= 1045-51 | pmid=pmid16944673 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16944673 }} </ref> | |||
===Medications=== | ===Medications=== | ||
*[[Acetazolamide]] | *Medications to treat any underlying causes | ||
*Medications to treat the day-time sleepiness | |||
:*[[Modafinil]] 200-400 mg per day | |||
*[[Acetazolamide]], [[medroxyprogesterone]], [[fluoxetine]], and [[protriptyline]] are not routinely used | |||
*[[Oxygen]] | *[[Oxygen]] | ||
*Low doses are used as a treatment for [[hypoxia]] but are discouraged due to side effects<ref name=PsychToday /><ref name="pmid11181239">{{Cite journal|author=Mayos M, Hernández Plaza L, Farré A, Mota S, Sanchis J |title=[The effect of nocturnal oxygen therapy in patients with sleep apnea syndrome and chronic airflow limitation] |language=Spanish |journal=Archivos de Bronconeumología |volume=37 |issue=2 |pages=65–8 |year=2001 |month=February |pmid=11181239 |url=http://www.elsevier.es/revistas/0300-2896/37/65}}</ref><ref name="pmid2609134">{{Cite journal|author=Breitenbücher A, Keller-Wossidlo H, Keller R |title=[Transtracheal oxygen therapy in obstructive sleep apnea syndrome] |language=German |journal=Schweizerische Medizinische Wochenschrift |volume=119 |issue=46 |pages=1638–41 |year=1989 |month=November |pmid=2609134}}</ref> | *Low doses are used as a treatment for [[hypoxia]] but are discouraged due to side effects<ref name=PsychToday /><ref name="pmid11181239">{{Cite journal|author=Mayos M, Hernández Plaza L, Farré A, Mota S, Sanchis J |title=[The effect of nocturnal oxygen therapy in patients with sleep apnea syndrome and chronic airflow limitation] |language=Spanish |journal=Archivos de Bronconeumología |volume=37 |issue=2 |pages=65–8 |year=2001 |month=February |pmid=11181239 |url=http://www.elsevier.es/revistas/0300-2896/37/65}}</ref><ref name="pmid2609134">{{Cite journal|author=Breitenbücher A, Keller-Wossidlo H, Keller R |title=[Transtracheal oxygen therapy in obstructive sleep apnea syndrome] |language=German |journal=Schweizerische Medizinische Wochenschrift |volume=119 |issue=46 |pages=1638–41 |year=1989 |month=November |pmid=2609134}}</ref> | ||
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:*A 2013 proof of concept trial found that dronabinol (synthetic THC) was able to reduce apnea indexes by 32% on average in the 17 human subjects that were studied.<ref>{{Cite journal|author=Prasad B, Radulovacki MG, Carley DW |title=Proof of concept trial of dronabinol in obstructive sleep apnea. |journal=Front Psychiatry |volume=4 |issue=1 |year=2013 |month=Jan |pmid=23346060 |pmc=3550518 |doi=10.3389/fpsyt.2013.00001}}</ref> | :*A 2013 proof of concept trial found that dronabinol (synthetic THC) was able to reduce apnea indexes by 32% on average in the 17 human subjects that were studied.<ref>{{Cite journal|author=Prasad B, Radulovacki MG, Carley DW |title=Proof of concept trial of dronabinol in obstructive sleep apnea. |journal=Front Psychiatry |volume=4 |issue=1 |year=2013 |month=Jan |pmid=23346060 |pmc=3550518 |doi=10.3389/fpsyt.2013.00001}}</ref> | ||
:*Lead study author Dr. David Carley subsequently received a $5 million grant from the National Institutes of Health (NIH) to conduct a Phase II clinical trial<ref>{{cite web |url=http://www.businesswire.com/news/home/20120814005790/en/Cortex-Pharmaceuticals-Pier-Pharmaceuticals-Consummate-Merger|title=Cortex Pharmaceuticals and Pier Pharmaceuticals Consummate Merger |author=<!--Staff writer(s); no by-line.--> |date=14 August 2012 |publisher=BusinessWire.com |accessdate=7 August 2013}}</ref> | :*Lead study author Dr. David Carley subsequently received a $5 million grant from the National Institutes of Health (NIH) to conduct a Phase II clinical trial<ref>{{cite web |url=http://www.businesswire.com/news/home/20120814005790/en/Cortex-Pharmaceuticals-Pier-Pharmaceuticals-Consummate-Merger|title=Cortex Pharmaceuticals and Pier Pharmaceuticals Consummate Merger |author=<!--Staff writer(s); no by-line.--> |date=14 August 2012 |publisher=BusinessWire.com |accessdate=7 August 2013}}</ref> | ||
===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<ref name="cpap-machines">[http://www.cpap-machine-reviews.com General Information about Sleep Apnea Machines]</ref> | |||
*The CPAP machine generates the required air pressure to keep the patient's airways open during sleep | |||
*Many patients refuse to continue the therapy or fail to use their CPAP machines on a nightly basis because they find it uncomfortable<ref name='Hsu2003'>{{Cite journal|author=Hsu AA, Lo C |title=Continuous positive airway pressure therapy in sleep apnoea |journal=Respirology |volume=8 |issue=4 |pages=447–54 |year=2003 |month=December |pmid=14708553 |doi=10.1046/j.1440-1843.2003.00494.x}}</ref> | |||
*One way to ensure [[CPAP]] therapy remains comfortable for patients is to ensure the CPAP face mask fits well | |||
*It is not clear that CPAP reduces [[hypertension]] or cardiovascular events in patients who do not have daytime sleepiness; however, the lack of benefit may be partly due to [[Compliance (medicine)|noncompliance]] with therapy<ref name="pmid22618923">{{cite journal |author=Barbé F, Durán-Cantolla J, Sánchez-de-la-Torre M, ''et al.'' |title=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 |journal=JAMA |volume=307 |issue=20 |pages=2161–8 |year=2012 |month=May |pmid=22618923 |doi=10.1001/jama.2012.4366 |url=http://jama.jamanetwork.com/article.aspx?doi=10.1001/jama.2012.4366}}</ref> | |||
===Oral appliances=== | |||
*Mandibular Advancement Splint | |||
:*A oral appliance placed by general dentists | |||
:*A custom-made mouthpiece that shifts the lower jaw forward and opens the bite slightly, which opens up the airway | |||
:*Oral appliance therapy (OAT) is usually successful in patients with mild to moderate obstructive sleep apnea<ref>{{Cite journal|author=Machado MA, Juliano L, Taga M, de Carvalho LB, do Prado LB, do Prado GF |title=Titratable mandibular repositioner appliances for obstructive sleep apnea syndrome: are they an option? |journal=Sleep & Breathing |volume=11 |issue=4 |pages=225–31 |year=2007 |month=December |pmid=17440760 |doi=10.1007/s11325-007-0109-y}}</ref> | |||
:*OAT is a relatively new treatment option for sleep apnea in the United States, but it is much more common in Canada and Europe | |||
==References== | ==References== | ||
Revision as of 15:33, 7 July 2015
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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 excessive daytime sleepiness, and many other ailments. Treatment often starts with behavioral therapy. Medical treatment involves treating the underlying cause and day-time sleepiness. 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.
Sleep Apnea Medical Therapy
The treatment often starts with behavioral therapy. Many patients are told to avoid alcohol, sleeping pills, and other sedatives, which can relax throat muscles, contributing 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.[1]
Medications
- Medications to treat any underlying causes
- Medications to treat the day-time sleepiness
- Modafinil 200-400 mg per day
- Acetazolamide, medroxyprogesterone, fluoxetine, and protriptyline are not routinely used
- Oxygen
- Low doses are used as a treatment for hypoxia but are discouraged due to side effects[2][3][4]
- Cannabis derivatives have also been studied in the treatment of sleep apnea
- A 2002 study found that orally administered THC was able to stabilize respiration in rats and bulldogs during all sleep stages, decreasing apnea indexes during NREM and REM sleep stages by 42% and 58% respectively.[5]
- A 2013 proof of concept trial found that dronabinol (synthetic THC) was able to reduce apnea indexes by 32% on average in the 17 human subjects that were studied.[6]
- Lead study author Dr. David Carley subsequently received a $5 million grant from the National Institutes of Health (NIH) to conduct a Phase II clinical trial[7]
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[8]
- The CPAP machine generates the required air pressure to keep the patient's airways open during sleep
- Many patients refuse to continue the therapy or fail to use their CPAP machines on a nightly basis because they find it uncomfortable[9]
- One way to ensure CPAP therapy remains comfortable for patients is to ensure the CPAP face mask fits well
- It is not clear that CPAP reduces hypertension or cardiovascular events in patients who do not have daytime sleepiness; however, the lack of benefit may be partly due to noncompliance with therapy[10]
Oral appliances
- Mandibular Advancement Splint
- A oral appliance placed by general dentists
- A custom-made mouthpiece that shifts the lower jaw forward and opens the bite slightly, which opens up the airway
- Oral appliance therapy (OAT) is usually successful in patients with mild to moderate obstructive sleep apnea[11]
- OAT is a relatively new treatment option for sleep apnea in the United States, but it is much more common in Canada and Europe
References
- ↑ 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). - ↑
- ↑ 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) - ↑ Carley DW, Paviovic S, Janelidze M, Radulovacki M (2002). "Functional role for cannabinoids in respiratory stability during sleep". Sleep. 25 (4): 391–8. PMID 12071539. Unknown parameter
|month=ignored (help) - ↑ Prasad B, Radulovacki MG, Carley DW (2013). "Proof of concept trial of dronabinol in obstructive sleep apnea". Front Psychiatry. 4 (1). doi:10.3389/fpsyt.2013.00001. PMC 3550518. PMID 23346060. Unknown parameter
|month=ignored (help) - ↑ "Cortex Pharmaceuticals and Pier Pharmaceuticals Consummate Merger". BusinessWire.com. 14 August 2012. Retrieved 7 August 2013.
- ↑ 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) - ↑ 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) - ↑ Machado MA, Juliano L, Taga M, de Carvalho LB, do Prado LB, do Prado GF (2007). "Titratable mandibular repositioner appliances for obstructive sleep apnea syndrome: are they an option?". Sleep & Breathing. 11 (4): 225–31. doi:10.1007/s11325-007-0109-y. PMID 17440760. Unknown parameter
|month=ignored (help)