Obstructive Sleep Apnea

© The main therapy for OSA is nasal continuous positive airway pressure (CPAP) therapy. CPAP alleviates sleep-disordered breathing by producing a positive pressure column in the upper airway using room air. The CPAP machine is small enough to be transportable and sits at the bedside. A flexible tube connects the CPAP machine to a mask that covers the nose. During overnight polysomnography, the pressure setting is increased until sleep-disordered breathing is eliminated. CPAP therapy has been shown to have a favorable impact on blood pressure and to attenuate some of the po tential hemodynamic and neurohumoral responses that may link OSA to systemic disease.

Table 41-3 Frequently Used Medications for RLS

UL'Menr. Nurnt I Brand NdinL-l

Hall ■ Life lliuunl

Dcit nange 1 mq''day)'

Fotirtllil Side Effect «1- Dliidvinug«

[hpititntrgic Agents'

Levodcpa/caibidopa (ilnc-rivi)

li-i

KJS-Xffl oi levtrttiu

Nausea/vomiting, hyh ticUencegl^nipiiim

augnientalkHi

PrflnnfieiKile Mnapen)

S-IJ*

M25HJ

lUauwM/vcimltinguiilccif cgmptiklwe liehfliiDrs"

HflpinirQlp

if

ajj-i

Mji ■ "ih/'Air- ii1 !: 1. rrfc i if < i.■ 111: siiImvi 1 heh.ivbi1

Anticonvulsants

Gsbipfntlri (Neu-cniin)

S-7'

Sti-isoa

lli/iines^. ataxia

Hypnotic Agents

Clonazepam (KlonopirV

JW-fD

flf-2

Tolerance, tan yo^er sedation

IPHTBiil)

10-15

7.5-30

iota a***. car< yoviei jerkin

Zolpidem (Amb<en)

2-2.V

5-10

Tolerance

Zaleplon f^ivnai

V

5-10

fcfciance, may not last entire night

dpi nidi

Hydrocodorw

IS-

S-IO

Constipalkm, nausea, sedation

Cedeine

Z-S-AJ'

30-i0

tjwfijMiiMv nausea, Kdation

PiofWK>ph<mc

6-12*

100 600

ConstipiJliwh ruuii'j. sedation

Oxycodone

12-11"

5-30

CcmstipalkKii nausea, sedation

"Usual range, all medicoH iufis jothe< 1 han dopaiririergk agents) are dosed at bedtime.

"Dtjtwminagic jgc-nt^ arc hr.-qucntlyyiiitrn ji bsdtimeOi 2 huuii prior to bedtime ur Iht- anlititMlttl onitu uiRE.5 syiriploriis. <Mjy be lunyiM in patkruis wilfui™ I dyslurctiofi

■^lompjIiivF behaviors such as gambling. liwuningi sexual bftarins and eating haw b?en n-norlFd in rw1x?nts taking DAi <Mjy(jiior<iei in fjatienw w'nh ht^tit ^function

I join Ret

"Usual range, all medicoH iufis jothe< 1 han dopaiririergk agents) are dosed at bedtime.

"Dtjtwminagic jgc-nt^ arc hr.-qucntlyyiiitrn ji bsdtimeOi 2 huuii prior to bedtime ur Iht- anlititMlttl onitu uiRE.5 syiriploriis. <Mjy be lunyiM in patkruis wilfui™ I dyslurctiofi

■^lompjIiivF behaviors such as gambling. liwuningi sexual bftarins and eating haw b?en n-norlFd in rw1x?nts taking DAi <Mjy(jiior<iei in fjatienw w'nh ht^tit ^function

I join Ret

Not all individuals tolerate CPAP therapy in part because it requires wearing a mask during sleep, and therapy can dry and irritate the upper airway. In some individuals, these barriers for adherence may be lessened or eliminated by properly fitting the mask, adding humidity or heat to therapy, or using bilevel positive airway pressure (BiPAP) therapy. BiPAP therapy applies a variable pressure into the airway during the inspiratory phase of respiration but, unlike CPAP, reduces the applied pressure during the expiratory phase of respiration.

There are other therapies for OSA. Obesity can worsen sleep apnea, and weight management should be implemented for all overweight patients with OSA. In obese patients with mild OSA, weight loss alone can be effective, and studies have reported improvement in severity of OSA with gastric stapling. For those patients who cannot tolerate CPAP, oral appliances can be used to advance the lower jawbone and to keep the tongue forward to enlarge the upper airway. For individuals who suffer OSA only during certain positions (e.g., when on their back) during sleep, positional therapies may be effective. Surgical therapy (uvulopalatopharyngoplasty) opens the upper airway by removing the tonsils, trimming and reorienting the posterior and anterior ton-

sillar pillars, and removing the uvula and posterior portion of the palate. This is not a first-line option because of its invasiveness. In very severe cases, tracheostomy may be necessary. This procedure may be indicated in selected individuals who are morbidly obese, have severe facial skeletal deformity, experience severe drops in oxygen saturation (e.g., SaO2 less than 70%), or have significant cardiac arrhythmias associated with their OSA.

There is no drug therapy for OSA. Drug therapy for symptoms of OSA may be considered in selected patients. For example, modafinil (Provigil) is a wake-promoting medication that is approved by the FDA to improve wakefulness in patients who have residual daytime sleepiness while treated with CPAP. Initiation of wake-promoting medications should be attempted only after patients are using optimal CPAP therapy to alleviate sleep-disordered breathing. Other therapies used in the past (e.g., medroxyprogesterone) are not effective and may worsen OSA. Untreated or inadequately treated sleep apnea may hinder achieving blood pressure control in hypertensive patients. OSA should be considered and evaluated in hypertensive patients who are resistant to therapy or have signs and symptoms of OSA.

Reducing Blood Pressure Naturally

Reducing Blood Pressure Naturally

Do You Suffer From High Blood Pressure? Do You Feel Like This Silent Killer Might Be Stalking You? Have you been diagnosed or pre-hypertension and hypertension? Then JOIN THE CROWD Nearly 1 in 3 adults in the United States suffer from High Blood Pressure and only 1 in 3 adults are actually aware that they have it.

Get My Free Ebook


Post a comment