Obstructive sleep apnea: A diagnostic and treatment guide
Patients with this common sleep disorder often fit the classic profile—but not always. Here’s help knowing what to look for and when to test, as well as how best to treat it.
Too little evidence of medications’ efficacy
Numerous drugs have been tested for the treatment of OSA. Two Cochrane reviews looked at multiple trials of more than 20 drugs, in meta-analyses encompassing more than 500 patients.42,43 Ten drugs—eszopiclone, paroxetine, acetazolamide, ondansetron-fluoxetine combination, naltrexone, and fluticasone nasal spray among them—showed a statistically significant reduction in AHI, and a few showed a subjective benefit in daytime sleepiness. However, the studies were very small and of short duration and the reviewers concluded that evidence is insufficient to recommend drug therapy for OSA.
CASE 1 CPAP was prescribed for Mr. M. He tolerated it well and after 2 weeks, he reported feeling refreshed upon awakening, having less daytime somnolence and being better able to concentrate at work. His hypertension and glucose control improved, but he continues to struggle with his weight.
CASE 2 Ms. C started CPAP and within a week, her morning headaches and irritability resolved.
CORRESPONDENCE
Cecilia Gutierrez, MD, 200 West Arbor Drive, Mail Code 8809, San Diego, CA 92103; cagutierrez@ucsd.edu
