Tackling obstructive sleep apnea with pharmacotherapeutics: expert guidance

ABSTRACT

Introduction

The efficacy of non-pharmacotherapeutic treatment of obstructive sleep apnea, a highly prevalent condition with serious cardiometabolic and neurocognitive health consequences, is well established. Supplementing traditional treatment strategies with medications can improve symptoms and reduce side effects. Efforts to identify medications that target the causes of sleep apnea have met with mixed success. However, this remains a worthwhile objective for researchers to pursue, given the potential benefit pharmacotherapy could bring to those patients who reject or struggle to adhere to existing treatments.

Areas covered

This article presents the case for obstructive sleep apnea pharmacotherapy including drugs that reduce the occurrence of apnea events, such as weight loss agents, ventilation activators and muscle and nervous system stimulants, drugs that alleviate symptoms, such as wake-promoting agents for excessive daytime sleepiness, and drugs that improve adherence to existing treatments, such as hypnotics. Literature was accessed from PubMed between 1 March 2024 and 18 April 2024.

Expert opinion

Exciting recent advances in both our understanding of obstructive sleep apnea pathology and in the techniques used to identify therapeutic agents and their targets combine to embolden a positive outlook for the expanded use of drugs in tackling this consequential disease.

KEYWORDS:

• CPAP
• sleep apnea
• pharmacotherapy
• treatment

Article highlights

• Whilst nasal positive airway pressure continues to be an effective treatment for obstructive sleep apnea (OSA), there is a strong interest in exploring pharmacological interventions.

• Pharmacotherapeutics, such as atomoxetine – oxybutynin combination therapy, can effectively reduce the number of respiratory events during the night.

• Drugs may also serve a purpose in supporting existing therapies by supplementing their effects on symptoms and increasing their tolerability to facilitate increased adherence.

• Recent advances in determining the pathophysiology of OSA pave the way for new candidate drugs targeted to specific patients.

• Additional novel therapeutic targets, such as gene-based therapies, may be detected by leveraging machine learning (ML) and artificial intelligence (AI) technologies.

Declaration of interest

A Malhotra has relevant affiliations with the following organizations: Zoll, Livanova, Eli Lilly and Powell Mansfield.

The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This paper was funded by the National Institutes on Aging (NIA) grant project number [5R01AG063925-03].