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A Journal on Psychiatry, Psychology and Psychopharmacology
Official Journal of the Italian Society of Social Psychiatry
Indexed/Abstracted in: EMBASE, e-psyche, PsycINFO, Scopus, Emerging Sources Citation Index
Minerva Psichiatrica 2005 September;46(3):147-58
Management of obstructive sleep apnea. Overview
Pierucci P., Lacedonia D., Resta O.
Obstructive sleep apnea syndrome (OSAS) is a common condition affecting 1-4% of the adult population. There are large consequences for public health because of the associated morbidity and mortality. It has been shown that patients with an apnea index (the number of episodes of apnea or hypopnea per hour of sleep) exceeding 20 results in a much higher mortality and should be treated. A weight-reducing diet should be considered an important element not only as a treatment option, but also in the prevention and management of OSAS because obesity compromises airway function by altering pharyngeal size or geometry. Patients with OSA should abstain from alcohol because it reduces the motor activity of the airway muscles. Thyroid hormone deficiency may also be associated with increased upper airway resistance and predispose to occlusion during sleep. Patients who use benzodiazepines, narcotics and barbiturates reported a clinically significant upper way obstruction. The role of drug therapy in the treatment of OSA is not well known. The 2 most extensively used pharmacological agents for treating OSA have been medroxyprogesterone and tricyclic antidepressants such as protriptyline. The use of an oral appliance for the treatment of snoring and OSA is a relatively new field, with the result that there are many unanswered questions in this regard but it could be a reliable option for treating socially destructive snoring. Surgical management should be direct to the anatomic regions involved and have specific goals for clearance at the respective obstruction levels. Presurgical evaluation for appreciation of the type of anatomic abnormality present and the degree of severity of OSA is very important.
Treatment of OSA by continuous positive airway pressure (CPAP) was first described by Sullivan et al. in 1981 and, since then, CPAP has become the first-line and most widely prescribed treatment for moderate-to-severe OSA. CPAP is immediately and consistently effective in relieving sleep apnea and daytime symptoms. Also auto-CPAP (also called intelligent or self-adjusted CPAP) can be used for titration before switching to constant CPAP machine or can be used for long term home therapy.