Pharmacologic Therapy for Obstructive Sleep Apnea - A Review.

Introduction

Sleep is an important aspect of human well-being. Healthy sleep leads to improved mental and physical health. However, individuals with breathing disorders have disturbed sleep. One such common condition is obstructive sleep apnea, which causes disruptions in sleep due to a halt in breathing.

What Is Obstructive Sleep Apnea?

Obstructive sleep apnea is noticed as pauses in breathing during sleep. Repeated collapse and blockage in the upper airway lead to this disorder. This blockage can last seconds or minutes and occurs multiple times during sleep. All this hampers sleep quality and sleep cycle. It is the most common sleep-breathing disorder, affecting the population by obstructing airways while sleeping.

Individuals suffering from this have increased daytime fatigue and difficulty concentrating, are found to be more irritable, and have shown an increased risk of accidents. Impaired cognitive function and decreased memory are noticed, leading to decreased quality of life. Furthermore, this is linked with several other diseases and conditions like hypertension and stroke.

What Are the Symptoms and Risk Factors?

Symptoms include:

1. Loud and persistent snoring. Often, the accompanying family member notices this.

2. Choking and gasping for breath.

3. Excess sleep and tiredness during the daytime.

4. Bad mood.

5. Cognitive impairments.

6. Sore throat.

7. Dry mouth.

8. Restless sleep.

9. High blood pressure.

10. Morning headaches.

It mainly affects the elderly population. It remains undiagnosed in several individuals.

Risk factors include:

1. Obesity: Excess weight, especially in the upper body region, can cause compression of the airway space.

2. Airway Diameter: A smaller airway diameter makes it more prone to obstruction.

3. Age: More commonly seen in the elderly. This could be because muscles are losing tone with age.

4. Gender: Men are commonly affected. This could be attributed to female hormones.

5. Genetics: There is a higher chance that a family member has it.

6. Smoking: Increases inflammation and causes harm to airways and lungs.

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What Are the Treatment Approaches?

Non-pharmacological treatment approaches are the first line of treatment. They mainly aim to identify the cause and address it. The effectiveness of these treatments varies from individual to individual. The choice of treatment should be made with the help of a specialist, who should consider all the factors, like the presence of other health conditions, severity of apnea, and patient preferences.

1. Lifestyle Modifications: Weight management should be done. Regular exercise with a balanced diet can have a positive impact. Avoiding junk food, alcohol, and tobacco also matters. Consuming caffeinated drinks should also be in control.

2. Surgery: Bariatric surgery, bypass, or banding- these surgical techniques are employed in those who cannot reduce body mass, irrespective of lifestyle changes and medications.

3. Continuous Positive Airway Pressure: This is a gold standard for treating moderate to severe apnea. This technique uses a mask that continuously gently delivers air, which helps prevent airway collapse.

4. Positional Therapy: This technique is employed in individuals who find sleeping in certain positions more troublesome for breathing. The individuals are encouraged to sleep in ways that make them feel better.

5. Dental Appliances: In individuals where airway obstruction is due to tongue obstruction, certain devices can be custom-made to reposition and lessen the obstruction.

6. Behavioral Therapy: Patients with insomnia are generally given therapy. This can be helpful for patients with apnea, too.

What Are the Pharmacological Approaches Used?

It is important to consult a healthcare provider or sleep medicine specialist before starting treatment. The doctor can tailor make a plan to help improve the patient's sleep, maintain wakefulness in the daytime, and provide continuous support and guidance in this journey. Joining a support group dealing with similar issues also has a positive impact.

1. Weight Loss Medications: Medications are considered adjuncts for those who do not see a change after lifestyle modifications. Medications include Naltrexone, Bupropion Orlistat, Phentermine, and Topiramate.

2. Nasal Decongestants: Nasal obstruction is targeted by this group. Oxymetazoline, a vasoconstrictor, showed considerable help. The functional assessment of the airway still needs to be carried out. Phenylephrine is also considered.

3. Pharyngeal Dilators: These medications mainly target serotonin. As its activity is diminished during REM sleep and leads to collapse of airways.

• Serotonergic medications include Buspirone, Selective serotonin reuptake inhibitors, Paroxetine, and Fluoxetine. They target muscle tone and also reduce airway collapse in sleep.

• Noradrenergic medications Protriptyline are mainly given to increase muscle tone in the upper airway system.

• Potassium channel blockers like Aminopyridine.

4. High Loop Gain: These systems control ventilation through a negative feedback loop. The blood gas levels are maintained between the limits. It has components such as the controller, plant, and delay pointer. Carbonic anhydrase inhibitors like Acetazolamide.

5. Reducing Sleep Arousal: Sedatives and hypnotics are used. Benzodiazepines give sedative, relaxant effects by working on neurotransmitters in the brain. Triazolam, Nitrazepam, Temazepam.

6. Z Drugs: They are nonbenzodiazepine drugs that work on brain neurotransmitters by producing inhibitory effects. They do not produce a relaxant effect and have fewer side effects compared to benzodiazepines. Eszopiclone, Zolpidem, Zopiclone. Orexin receptor antagonists like Suvorexant block the neurotransmitter related to being awake. These drugs are used as sleep aids.

7. Awake Medicine: Medications that promote wakefulness during the daytime. Modafinil and Armodafinil are stimulant medications that are considered in patients who complain of excessive daytime fatigue and sleep. This helps them concentrate on their day-to-day activities.

Future directions include:

1. Novel Medicine: Use of cannabinoid receptor modulators, medications like Dronabinol are researched for apnea patients. They are studied to see if there is an influence on the stability of airways.

2. Pharmacogenetics: It identifies genetic factors that can affect the medicine effect. Studying in this regard can open doors for more personalized and targeted therapies.

3. Combination Therapies: A combination of medicines utilized from different classes with the intent to produce the most beneficial treatment outcome

4. Neuromodulation: Techniques to stimulate nerves supplying the airways are under research.

Conclusion

Obstructive sleep apnea is an alarming condition that affects the life of the individual negatively. However, it is manageable if diagnosed early and appropriate treatment is started. Lifestyle modifications, pharmacological interventions, and advanced modalities like continuous positive airway pressure are all helpful in providing a better life. Before starting any medication, the patient should consult the health care specialist and follow the instructions carefully. Regular follow-ups and dose adjustments must be carried out when necessary. By doing so, individuals can enhance their sleep cycle and make the best of it.