PHARMACOLOGICAL TREATMENT OF SLEEP-DISORDERED BREATHING

Available literature on the use of pharmacologic agents for the treatm ent of sleep-disordered breathing was reviewed by evidenced-based meth odology. Evidence tables were created and studies were graded accordin g to study design and the number of subjects included. Scores for each group of studies evaluating each pharmacologic agent were established so that the quality of research for different drugs could be compared . The use of various ventilatory stimulants, psychotropic drugs, and a ntihypertensive agents were reviewed. The most objective data are avai lable on theophylline and opioid antagonist/nicotine groups. Although more controlled studies would be helpful, relatively clear-cut indicat ions for the use of ventilatory stimulants exist for hypercapnic obesi ty-hypoventilation patients (medroxyprogesterone), myxedema (thyroid r eplacement), central apnea (acetazolamide), and periodic breathing in congestive heart failure (theophylline). Few randomized, well-controll ed trials have been published that evaluate pharmacologic agents in th e treatment of classic OSA. To date, no one agent stands out as being useful for OSA. Future research will need to characterize subjects so that various subsets of patients can be tried on one or on a combinati on of various pharmacologic agents.