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Official Journal of the Italian Society of Thoracic Endoscopy
Indexed/Abstracted in: EMBASE, Scopus
Online ISSN 1827-1723
Smith I. E.
Respiratory Support and Sleep Centre Papworth Hospital Papworth Everard, Cambridge, UK
Obstructive sleep apnoea (OSA) is a common condition with consequences for quality of life and life expectancy. Since the airway is patent during wakefulness, it seems reasonable to predict that either singly or in combination pharmacological manipulation of respiratory drive, airway tone or calibre and the consistency of airway secretions could maintain a patent airway during sleep. However to date a large number of drugs have been studied with only a few shown to have any benefits. Drugs affecting respiratory drive have been ineffective or poorly tolerated. Paroxetine inhibits reuptake of serotonin (5HT) and can reduce the apnoea/ hypopnoea index (AHI) during non rapid eye movement (REM) sleep, but has no impact during REM or on symptoms in the daytime. Mirtazapine combining central and peripheral actions on 5HT receptors reduced the AHI in a small clinical trial but not in follow-up commercial studies. Cholinergic pathways may be important and physostigmine can reduce the AHI in REM in non obese patients, but this is based on a single night study and there are no data on symptoms. In patients with both mild OSA and upper airway inflammation topical steroids can be helpful. In those in whom sleep apnoea cannot be eliminated, it may be useful to treat some of the consequences of the condition. Antihypertensive drugs have been shown to be safe in this population and do not exacerbate the sleep disordered breathing. In patients who are treated with continuous positive airway pressure but remain sleepy, modafinil can improve daytime symptoms and armodafinil is effective but not yet licensed.