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Review: Medical Therapy for Obstructive Sleep Apnea

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Posted: 9/14/2006

COLUMBUS, Ohio – Research from the past 20 years may yield clues for more effective therapeutic options for patients with obstructive sleep apnea, according to a review by researchers.

The review, involving clinical trials of patients with obstructive sleep apnea (OSA), revealed several practical findings involving alternative medical therapies, such as weight reduction, treatment by means of drugs, delivery of supplemental oxygen and positional therapies.

Doctor Ulysses Magalang
Ulysses J. Magalang, M.D.

The researchers published their findings on the effectiveness of alternative medical therapies in the journal Sleep.

“In order to increase strides toward the development of universally effective pharmacotherapies for sleep apnea, a greater knowledge of underlying neurochemical mechanisms that control the patency of the upper airway is necessary,” said Dr. Ulysses Magalang, medical director of Ohio State University Medical Center’s Sleep Disorders Center and co-author of the review.

The data concluded that a low calorie diet can lead to sufficient weight loss, thus improving OSA. Weight reduction has additional health benefits and should be routinely recommended as an adjunctive therapy for overweight patients with OSA.

Currently, effective medications for individuals with sleep apnea are rare, with the exception of patients with underlying medical disorders that are predisposing factors for their sleep apnea.

OSA is a common sleep disorder in which breathing is interrupted for brief periods during sleep. Some patients with this highly prevalent syndrome tolerate positive airway pressure (PAP) and achieve successful outcomes from either surgical procedures or the use of an oral appliance. However, PAP may not be effective in other patients.

Furthermore, in the subset of patients with OSA in whom residual sleepiness persists despite adequate treatment with PAP, treatment with a wakefulness-promoting medication can lead to a significant improvement in objective sleepiness.

“It is extremely important, as we move forward, to design well-controlled studies that examine the effects of pharmacotherapies on all health-related outcomes shown to be beneficial with PAP therapy,” says Magalang, also a pulmonologist and critical care specialist at OSU Medical Center.

Because of study design limitations and insufficient knowledge of the neurochemical mechanisms through which sleep places the upper airway at risk for collapse, it is currently unclear which patients will benefit from supplemental oxygen, what the optimal dose is, and what the long-term consequences and benefits of supplemental oxygen use are.

Positional therapy shows benefits in some patients, but whether or not it reduces morbidity, as PAP therapy does, remains to be seen.

“Hopefully, this review and infrastructure of knowledge will provide a basis for improving the design of future studies, as we continue to search for more effective medical therapeutic options for patients with OSA,” says Magalang.

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Sherri L. Kirk
Medical Center Communications

Healthy Living; Lung Diseases; OSU Medical Center; Researchers; Sleep Medicine; University Hospital; Wellness