Drug therapy for obstructive sleep apnoea in adults

Area of Science:

• Sleep Medicine
• Pharmacology
• Respiratory Medicine

Background:

• Continuous positive airways pressure (CPAP) is the standard treatment for moderate to severe obstructive sleep apnoea (OSA).
• CPAP is not universally tolerated, and its effectiveness in mild OSA is unproven.
• Drug therapy is being explored as an alternative for patients intolerant to CPAP or with mild to moderate OSA.

Purpose of the Study:

• To evaluate the effectiveness of various drug therapies in treating obstructive sleep apnoea (OSA).
• To identify potential alternative pharmacological treatments for patients with OSA.

Main Methods:

• Conducted systematic searches of the Cochrane Airways Group Specialised Register of trials.
• Included randomized, placebo-controlled trials of adult patients with confirmed OSA.
• Excluded trials using CPAP, mandibular devices, or oxygen therapy.

Main Results:

• Twenty-six trials involving 21 drugs and 394 participants were analyzed.
• Most studies were small with methodological limitations; diagnostic criteria were not always explicit.
• Six drugs showed some impact on OSA severity, and two improved daytime symptoms; notable reductions in apnoea-hypopnoea index (AHI) were observed with intranasal fluticasone, physostigmine, mirtazipine, and nasal lubricant.

Conclusions:

• Insufficient evidence currently supports the recommendation of drug therapy for OSA treatment.
• Short-term studies indicate potential benefits of certain agents in reducing AHI.
• Longer-term studies are required to assess the impact of drugs like fluticasone, mirtazipine, physostigmine, and nasal lubricant on daytime symptoms, and personalized drug-matching strategies need further investigation.