Drug treatments for obstructive sleep apnoea.

Area of Science:

• Pulmonology
• Sleep Medicine
• Pharmacology

Background:

• Obstructive sleep apnoea (OSA) is commonly treated with continuous positive airway pressure (CPAP).
• CPAP is not universally tolerated, and its efficacy in mild OSA is unproven.
• Drug therapies have been explored as alternatives to CPAP for mild to moderate OSA.

Purpose of the Study:

• To evaluate the effectiveness of pharmacological interventions for sleep apnoea.
• To identify potential mechanisms of drug action in reducing OSA.

Main Methods:

• Systematic review of double-blind, randomized placebo-controlled trials.
• Searches conducted on the Cochrane Airways Group RCT Register and through hand searching.
• Included trials excluded CPAP, mandibular devices, and oxygen therapy; no language or duration restrictions.

Main Results:

• Acetazolamide was the only drug to reduce the Hypopnoea Index (1 trial, 9 patients), but without symptomatic improvement and with poor tolerability.
• Protriptyline showed symptomatic improvement in two trials (13 patients) but did not alter apnoea frequency.
• No beneficial effects were observed for medroxy progesterone, clonidine, buspirone, aminophylline, theophylline, or sabeluzole.

Conclusions:

• Available data do not support the use of the examined drugs for OSA treatment.
• Despite study limitations, the findings suggest limited justification for further trials of these specific agents.
• Alternative or improved pharmacological strategies may be needed for OSA management.