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==Overview==
==Overview==
If left untreated, sleep apnea can have serious and life-threatening consequences such [[heart disease]], [[hypertension]], automobile accidents due to excessive daytime sleepiness, and many other ailments.  Treatment often starts with [[behavioral therapy]]. Medical treatment involves treating the underlying cause and day-time sleepiness. Medications, such as [[acetazolamide]] and [[oxygen]] are not routinely used for the treatment of sleep apnea. The most effective treatments help open the airway such as [[continuous positive airway pressure]] (CPAP) and oral appliances.
If left untreated, sleep apnea can have serious and life-threatening consequences such [[heart disease]], [[hypertension]], automobile accidents due to excessive daytime sleepiness, and many other ailments.  Treatment often starts with [[behavioral therapy]]. Medical treatment involves treatment of the underlying cause and somnolence. Medications, such as [[acetazolamide]] and [[oxygen]] are not routinely used for the treatment of sleep apnea. The most effective treatments help open the airway such as [[continuous positive airway pressure]] (CPAP) and oral appliances.


==Sleep Apnea Medical Therapy==
==Sleep Apnea Medical Therapy==
The treatment often starts with [[behavioral therapy]]. Many patients are told to avoid [[alcohol]], sleeping pills, and other [[sedatives]], which can relax throat muscles, contributing to the collapse of the airway at night.
The treatment often starts with [[behavioral therapy]]. Many patients are told to lose weight and avoid [[alcohol]], sleeping pills, and other[[sedatives]]. These can relax throat muscles, contributing to the collapse of the airway at night.


Possibly owing to changes in pulmonary oxygen stores, sleeping on one's side (as opposed to on one's back) has been found to be helpful for central sleep apnea with [[Cheyne-Stokes respiration]].<ref name="pmidpmid16944673">{{cite journal| author=Szollosi I, Roebuck T, Thompson B, Naughton MT| title=Lateral sleeping position reduces severity of central sleep apnea / Cheyne-Stokes respiration. | journal=Sleep | year= 2006 | volume= 29 | issue= 8 | pages= 1045-51 | pmid=pmid16944673 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16944673  }} </ref>
Possibly owing to changes in pulmonary oxygen stores, sleeping on one's side (as opposed to on one's back) has been found to be helpful for central sleep apnea with [[Cheyne-Stokes respiration]].<ref name="pmidpmid16944673">{{cite journal| author=Szollosi I, Roebuck T, Thompson B, Naughton MT| title=Lateral sleeping position reduces severity of central sleep apnea / Cheyne-Stokes respiration. | journal=Sleep | year= 2006 | volume= 29 | issue= 8 | pages= 1045-51 | pmid=pmid16944673 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16944673  }} </ref>


===Medications===
*Medications to treat any underlying causes
*Medications to treat the day-time sleepiness
:*[[Modafinil]] 200-400 mg per day
*[[Acetazolamide]], [[medroxyprogesterone]], [[fluoxetine]], and [[protriptyline]] are ventilatory stimulants are not routinely used<ref name="HudgelThanakitcharu1998">{{cite journal|last1=Hudgel|first1=David W.|last2=Thanakitcharu|first2=Sitthep|title=Pharmacologic Treatment of Sleep-disordered Breathing|journal=American Journal of Respiratory and Critical Care Medicine|volume=158|issue=3|year=1998|pages=691–699|issn=1073-449X|doi=10.1164/ajrccm.158.3.9802019}}</ref>
*[[Oxygen]]
*Low doses are used as a treatment for [[hypoxia]] but are discouraged due to side effects<ref name="pmid11181239">{{Cite journal|author=Mayos M, Hernández Plaza L, Farré A, Mota S, Sanchis J |title=[The effect of nocturnal oxygen therapy in patients with sleep apnea syndrome and chronic airflow limitation] |language=Spanish |journal=Archivos de Bronconeumología |volume=37 |issue=2 |pages=65–8 |year=2001 |month=February |pmid=11181239 |url=http://www.elsevier.es/revistas/0300-2896/37/65}}</ref><ref name="pmid2609134">{{Cite journal|author=Breitenbücher A, Keller-Wossidlo H, Keller R |title=[Transtracheal oxygen therapy in obstructive sleep apnea syndrome] |language=German |journal=Schweizerische Medizinische Wochenschrift |volume=119 |issue=46 |pages=1638–41 |year=1989 |month=November |pmid=2609134}}</ref>
*[[Cannabis]] derivatives have also been studied in the treatment of sleep apnea
:*A 2002 study found that orally administered [[Tetrahydrocannabinol]] [[THC]] was able to stabilize respiration in rats and bulldogs during all sleep stages, decreasing apnea indexes during NREM and REM sleep stages by 42% and 58% respectively.<ref>{{Cite journal|author=Carley DW, Paviovic S, Janelidze M, Radulovacki M |title=Functional role for cannabinoids in respiratory stability during sleep. |journal=Sleep |volume=25 |issue=4 |pages=391–8 |year=2002 |month=June |pmid=12071539}}</ref>
:*A 2013 proof of concept trial found that dronabinol (synthetic THC) was able to reduce apnea indexes by 32% on average in the 17 human subjects that were studied.<ref>{{Cite journal|author=Prasad B, Radulovacki MG, Carley DW |title=Proof of concept trial of dronabinol in obstructive sleep apnea. |journal=Front Psychiatry |volume=4 |issue=1 |year=2013 |month=Jan |pmid=23346060 |pmc=3550518 |doi=10.3389/fpsyt.2013.00001}}</ref>
:*Lead study author Dr. David Carley subsequently received a $5 million grant from the National Institutes of Health (NIH) to conduct a Phase II clinical trial<ref>{{cite web |url=http://www.businesswire.com/news/home/20120814005790/en/Cortex-Pharmaceuticals-Pier-Pharmaceuticals-Consummate-Merger|title=Cortex Pharmaceuticals and Pier Pharmaceuticals Consummate Merger |author=<!--Staff writer(s); no by-line.--> |date=14 August 2012 |publisher=BusinessWire.com |accessdate=7 August 2013}}</ref>


===Continuous positive airway pressure===
===Continuous positive airway pressure===
Line 28: Line 17:
*The patient typically wears a plastic facial mask, which is connected by a flexible tube to a small bedside CPAP machine<ref name="cpap-machines">[http://www.cpap-machine-reviews.com General Information about Sleep Apnea Machines]</ref>  
*The patient typically wears a plastic facial mask, which is connected by a flexible tube to a small bedside CPAP machine<ref name="cpap-machines">[http://www.cpap-machine-reviews.com General Information about Sleep Apnea Machines]</ref>  
*The CPAP machine generates the required air pressure to keep the patient's airways open during sleep
*The CPAP machine generates the required air pressure to keep the patient's airways open during sleep
*Many patients refuse to continue the therapy or fail to use their CPAP machines on a nightly basis because they find it uncomfortable<ref name='Hsu2003'>{{Cite journal|author=Hsu AA, Lo C |title=Continuous positive airway pressure therapy in sleep apnoea |journal=Respirology |volume=8 |issue=4 |pages=447–54 |year=2003 |month=December |pmid=14708553 |doi=10.1046/j.1440-1843.2003.00494.x}}</ref>  
*There may be low compliance because patients find it uncomfortable<ref name='Hsu2003'>{{Cite journal|author=Hsu AA, Lo C |title=Continuous positive airway pressure therapy in sleep apnoea |journal=Respirology |volume=8 |issue=4 |pages=447–54 |year=2003 |month=December |pmid=14708553 |doi=10.1046/j.1440-1843.2003.00494.x}}</ref>  
*One way to ensure [[CPAP]] therapy remains comfortable for patients is to ensure the CPAP face mask fits well
*One way to ensure [[CPAP]] therapy remains comfortable for patients is to ensure the CPAP face mask fits well
*It is not clear that CPAP reduces [[hypertension]] or cardiovascular events in patients who do not have daytime sleepiness; however, the lack of benefit may be partly due to [[Compliance (medicine)|noncompliance]] with therapy<ref name="pmid22618923">{{cite journal |author=Barbé F, Durán-Cantolla J, Sánchez-de-la-Torre M, ''et al.'' |title=Effect of continuous positive airway pressure on the incidence of hypertension and cardiovascular events in nonsleepy patients with obstructive sleep apnea: a randomized controlled trial |journal=JAMA |volume=307 |issue=20 |pages=2161–8 |year=2012 |month=May |pmid=22618923 |doi=10.1001/jama.2012.4366 |url=http://jama.jamanetwork.com/article.aspx?doi=10.1001/jama.2012.4366}}</ref>
*It is not clear that CPAP reduces [[hypertension]] or cardiovascular events in patients who do not have somnolence; however, the lack of benefit may be partly due to [[Compliance (medicine)|noncompliance]] with therapy<ref name="pmid22618923">{{cite journal |author=Barbé F, Durán-Cantolla J, Sánchez-de-la-Torre M, ''et al.'' |title=Effect of continuous positive airway pressure on the incidence of hypertension and cardiovascular events in nonsleepy patients with obstructive sleep apnea: a randomized controlled trial |journal=JAMA |volume=307 |issue=20 |pages=2161–8 |year=2012 |month=May |pmid=22618923 |doi=10.1001/jama.2012.4366 |url=http://jama.jamanetwork.com/article.aspx?doi=10.1001/jama.2012.4366}}</ref>


===Oral appliances===
===Oral appliances===
Line 38: Line 27:
:*Oral appliance therapy (OAT) is usually successful in patients with mild to moderate obstructive sleep apnea<ref>{{Cite journal|author=Machado MA, Juliano L, Taga M, de Carvalho LB, do Prado LB, do Prado GF |title=Titratable mandibular repositioner appliances for obstructive sleep apnea syndrome: are they an option? |journal=Sleep & Breathing |volume=11 |issue=4 |pages=225–31 |year=2007 |month=December |pmid=17440760 |doi=10.1007/s11325-007-0109-y}}</ref>  
:*Oral appliance therapy (OAT) is usually successful in patients with mild to moderate obstructive sleep apnea<ref>{{Cite journal|author=Machado MA, Juliano L, Taga M, de Carvalho LB, do Prado LB, do Prado GF |title=Titratable mandibular repositioner appliances for obstructive sleep apnea syndrome: are they an option? |journal=Sleep & Breathing |volume=11 |issue=4 |pages=225–31 |year=2007 |month=December |pmid=17440760 |doi=10.1007/s11325-007-0109-y}}</ref>  
:*OAT is a relatively new treatment option for sleep apnea in the United States, but it is much more common in Canada and Europe
:*OAT is a relatively new treatment option for sleep apnea in the United States, but it is much more common in Canada and Europe
===Pharmacological Agents===
*Medications to treat any underlying causes
*Medications to treat somnolence
:*[[Modafinil]] 200-400 mg per day
*[[Acetazolamide]], [[medroxyprogesterone]], [[fluoxetine]], and [[protriptyline]] are ventilatory stimulants that are not routinely used<ref name="HudgelThanakitcharu1998">{{cite journal|last1=Hudgel|first1=David W.|last2=Thanakitcharu|first2=Sitthep|title=Pharmacologic Treatment of Sleep-disordered Breathing|journal=American Journal of Respiratory and Critical Care Medicine|volume=158|issue=3|year=1998|pages=691–699|issn=1073-449X|doi=10.1164/ajrccm.158.3.9802019}}</ref>
==Oxygen Therapy==
*Low doses are used as a treatment for [[hypoxia]] but are discouraged due to side effects<ref name="pmid11181239">{{Cite journal|author=Mayos M, Hernández Plaza L, Farré A, Mota S, Sanchis J |title=[The effect of nocturnal oxygen therapy in patients with sleep apnea syndrome and chronic airflow limitation] |language=Spanish |journal=Archivos de Bronconeumología |volume=37 |issue=2 |pages=65–8 |year=2001 |month=February |pmid=11181239 |url=http://www.elsevier.es/revistas/0300-2896/37/65}}</ref><ref name="pmid2609134">{{Cite journal|author=Breitenbücher A, Keller-Wossidlo H, Keller R |title=[Transtracheal oxygen therapy in obstructive sleep apnea syndrome] |language=German |journal=Schweizerische Medizinische Wochenschrift |volume=119 |issue=46 |pages=1638–41 |year=1989 |month=November |pmid=2609134}}</ref>


==References==
==References==

Revision as of 16:00, 8 July 2015

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Saarah T. Alkhairy, M.D.

Overview

If left untreated, sleep apnea can have serious and life-threatening consequences such heart disease, hypertension, automobile accidents due to excessive daytime sleepiness, and many other ailments. Treatment often starts with behavioral therapy. Medical treatment involves treatment of the underlying cause and somnolence. Medications, such as acetazolamide and oxygen are not routinely used for the treatment of sleep apnea. The most effective treatments help open the airway such as continuous positive airway pressure (CPAP) and oral appliances.

Sleep Apnea Medical Therapy

The treatment often starts with behavioral therapy. Many patients are told to lose weight and avoid alcohol, sleeping pills, and othersedatives. These can relax throat muscles, contributing to the collapse of the airway at night.

Possibly owing to changes in pulmonary oxygen stores, sleeping on one's side (as opposed to on one's back) has been found to be helpful for central sleep apnea with Cheyne-Stokes respiration.[1]


Continuous positive airway pressure

  • For moderate to severe sleep apnea, CPAP therapy is extremely effective in reducing apneas and less expensive than other treatments
  • It 'splints' the patient's airway open during sleep by means of a flow of pressurized air into the throat
  • The patient typically wears a plastic facial mask, which is connected by a flexible tube to a small bedside CPAP machine[2]
  • The CPAP machine generates the required air pressure to keep the patient's airways open during sleep
  • There may be low compliance because patients find it uncomfortable[3]
  • One way to ensure CPAP therapy remains comfortable for patients is to ensure the CPAP face mask fits well
  • It is not clear that CPAP reduces hypertension or cardiovascular events in patients who do not have somnolence; however, the lack of benefit may be partly due to noncompliance with therapy[4]

Oral appliances

  • Mandibular Advancement Splint
  • A oral appliance placed by general dentists
  • A custom-made mouthpiece that shifts the lower jaw forward and opens the bite slightly, which opens up the airway
  • Oral appliance therapy (OAT) is usually successful in patients with mild to moderate obstructive sleep apnea[5]
  • OAT is a relatively new treatment option for sleep apnea in the United States, but it is much more common in Canada and Europe

Pharmacological Agents

  • Medications to treat any underlying causes
  • Medications to treat somnolence

Oxygen Therapy

  • Low doses are used as a treatment for hypoxia but are discouraged due to side effects[7][8]



References

  1. ↑ Szollosi I, Roebuck T, Thompson B, Naughton MT (2006). "Lateral sleeping position reduces severity of central sleep apnea / Cheyne-Stokes respiration". Sleep. 29 (8): 1045–51. PMID pmid16944673 Check |pmid= value (help).
  2. ↑ General Information about Sleep Apnea Machines
  3. ↑ Hsu AA, Lo C (2003). "Continuous positive airway pressure therapy in sleep apnoea". Respirology. 8 (4): 447–54. doi:10.1046/j.1440-1843.2003.00494.x. PMID 14708553. Unknown parameter |month= ignored (help)
  4. ↑ Barbé F, Durán-Cantolla J, Sánchez-de-la-Torre M; et al. (2012). "Effect of continuous positive airway pressure on the incidence of hypertension and cardiovascular events in nonsleepy patients with obstructive sleep apnea: a randomized controlled trial". JAMA. 307 (20): 2161–8. doi:10.1001/jama.2012.4366. PMID 22618923. Unknown parameter |month= ignored (help)
  5. ↑ Machado MA, Juliano L, Taga M, de Carvalho LB, do Prado LB, do Prado GF (2007). "Titratable mandibular repositioner appliances for obstructive sleep apnea syndrome: are they an option?". Sleep & Breathing. 11 (4): 225–31. doi:10.1007/s11325-007-0109-y. PMID 17440760. Unknown parameter |month= ignored (help)
  6. ↑ Hudgel, David W.; Thanakitcharu, Sitthep (1998). "Pharmacologic Treatment of Sleep-disordered Breathing". American Journal of Respiratory and Critical Care Medicine. 158 (3): 691–699. doi:10.1164/ajrccm.158.3.9802019. ISSN 1073-449X.
  7. ↑ Mayos M, Hernández Plaza L, Farré A, Mota S, Sanchis J (2001). "[The effect of nocturnal oxygen therapy in patients with sleep apnea syndrome and chronic airflow limitation]". Archivos de Bronconeumología (in Spanish). 37 (2): 65–8. PMID 11181239. Unknown parameter |month= ignored (help)
  8. ↑ Breitenbücher A, Keller-Wossidlo H, Keller R (1989). "[Transtracheal oxygen therapy in obstructive sleep apnea syndrome]". Schweizerische Medizinische Wochenschrift (in German). 119 (46): 1638–41. PMID 2609134. Unknown parameter |month= ignored (help)

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