Drug Therapy for Obstructive Sleep Apnoea

Obstructive sleep apnea (OSA) is a common disorder that is characterized by obstructive apnoeas and hypopneas due to the repetitive collapse of the upper airway during sleep. A variety of effective behavioral and airway-specific therapies are available for the treatment of OSA, including weight loss, positive airway pressure therapy, oral appliances, and surgical procedures. Behavior modification is indicated for most patients who have OSA. This includes losing weight, exercising, abstaining from alcohol, and avoiding certain medications. For patients with severe OSA, positive airway pressure is recommended as initial therapy. Oral appliance may be tried for patients with mild to moderate OSA. Surgical therapy is usually for the surgically correctable obstructing lesion. Hypoglossal nerve stimulation via an implantable neurostimulator device is a novel treatment strategy. Patients who continue to have excessive daytime sleepiness despite adequate OSA-specific therapy that is severe enough to warrant treatment may benefit from adjunctive pharmacologic therapy like modafinil and armodafinil. Other drugs have been tried in the management of OSA. In small trials, benefits have been found sporadically with remifentanil, zolpidem, triazolam, eszopiclone, and sodium oxybate. Further large multicentric trials are required to prove their efficacy. There is also a scope for research for thedevelopment of some novel group of drugs for the primary treatment for OSA.