[Obstructive sleep apnea syndrome: medical treatment]

Medical management of patients with obstructive sleep apnea syndrome (OSAS) implies a multidisciplinary organization. Dietary advice is always needed because the great majority of these patients are significantly overweight. Drinking alcoholic beverages before bedtime and smoking must be advised against. Re-learning good sleeping habits is also necessary for certain patients with a chronic disorder. In patients with a mild to moderate OSAS, or whose diagnostic tracing demonstrates position-related respiratory events, it may be useful to avoid dorsal decubitus when sleeping. Sedatives should of course be totally avoided. Drug treatment for OSAS has generally been disappointing, but new serotoninergic receptor antagonists offer new possibilities. Medical management of associated conditions such as hypothyroidism must also be an integral part of the long term treatment of OSAS. The gold standard treatment remains continuous nocturnal positive pressure ventilation with proven efficacy largely demonstrated in several controlled trials showing often spectacular response within days. Prescription is guided by the intensity of the clinical diurnal and nocturnal symptoms, better results being obtained in patients with a high index of respiratory events. For patients with mild to moderate disease (index < 30) or for patients with severe disease who do not tolerate positive pressure ventilation, surgery or a mandibular advancement device should be considered.