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: heart disease, hypertension, automobile accidents due to excessive daytime sleepiness, and many other ailments. 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.[1]
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.[2]
Medical Treatment
Medications
- Lower blood pH and encourage respiration
- Low doses of oxygen are also used as a treatment for hypoxia but are discouraged due to side effects.[4][5][6]
Oral appliances
- 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[7]
- OAT is a relatively new treatment option for sleep apnea in the United States, but it is much more common in Canada and Europe
===Continuous positive airway pressure===[[ File:Cpapanwender.jpg|thumb|Patient using a CPAP machine. There are many models of CPAP face masks.]] For moderate to severe sleep apnea, the most common treatment is the use of a continuous positive airway pressure (CPAP) or automatic positive airway pressure (APAP) device[1]
- 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]
Alternative Therapies
Other studies have also suggested that strengthening the muscles around the upper airway may combat sleep apnea. A 2001 study investigated changes after Tongue Muscle Training (ZMT®) in respiratory parameters during night-time sleep of patients with increased respiratory disease index. 40 sleep apnea patients, which up to this time had been treated with nCPAP, underwent electrostimulation of the suprahyoidal musculature for 5 weeks with a special EMS-device. The apnea, hypopnea and desaturation indexes were reduced in 26 of the 40 patients (65%) by an average of approximately one half.[11] A 2005 study in the British Medical Journal found that learning and practicing the didgeridoo helped reduce snoring and sleep apnea as well as daytime sleepiness. This appears to work by strengthening muscles in the upper airway, thus reducing their tendency to collapse during sleep.[12] A 2009 study published in the American Journal of Respiratory and Clinical Care Medicine found that patients who practiced a series of tongue and throat exercises for 30 minutes a day showed a marked decline in sleep apnea symptoms after three months. Patients experienced an average of 39% fewer apnea episodes after successfully completing the treatments. [13]
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.[14] 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.[15] 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.[16]
References
- ↑ 1.0 1.1 "How Is Sleep Apnea Treated?". National Heart, Lung, and Blood Institute.
- ↑ 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). - ↑ White DP, Zwillich CW, Pickett CK, Douglas NJ, Findley LJ, Weil JV (1982). "Central sleep apnea: Improvement with acetazolamide therapy". Archives of Internal Medicine. 142 (10): 1816–9. doi:10.1001/archinte.142.10.1816. PMID 6812522. Unknown parameter
|month=ignored (help) - ↑ 4.0 4.1 "Sleep Apnea". Diagnosis Dictionary. Psychology Today.
- ↑ 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) - ↑ 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) - ↑ 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) - ↑ Gessmann HW et al: The Tongue Muscle Training (ZMT®) in nCPAP Patients with Obstructive Sleep Apnea Syndrome (OSAS). PIB Publisher Duisburg, Germany 2001
- ↑ Puhan MA, Suarez A, Lo Cascio C, Zahn A, Heitz M, Braendli O (2006). "Didgeridoo playing as alternative treatment for obstructive sleep apnoea syndrome: randomised controlled trial". BMJ. 332 (7536): 266–70. doi:10.1136/bmj.38705.470590.55. PMC 1360393. PMID 16377643. Unknown parameter
|month=ignored (help) - ↑ Guimarães KC, Drager LF, Genta PR, Marcondes BF, Lorenzi-Filho G (2009). "Effects of oropharyngeal exercises on patients with moderate obstructive sleep apnea syndrome". Am. J. Respir. Crit. Care Med. 179 (10): 962–6. doi:10.1164/rccm.200806-981OC. PMID 19234106. 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.