Therapeutics for Sleep-disordered Breathing

Obstructive sleep apnea (OSA) is a common disorder, and obesity is a known risk factor for its development. Continuous positive airway pressure (CPAP) therapy is the standard treatment in OSA but is not always well accepted by the patients, partly because of its pressure-related side effects. Daytime hypersomnia is not always present in patients with OSA, and this subgroup of patients is even less likely to accept CPAP therapy. As a result, the long-term compliance with CPAP can vary between individuals. In addition, CPAP may not completely alleviate the symptoms associated with OSA, such as daytime hypersomnia. This article reviews the established evidence supporting medical therapy as an alternative to CPAP for OSA. Despite multiple trials with various medications, the current data do not support any particular pharmacologic treatment that could be significantly beneficial, suggesting that the pathophysiology underlying OSA is multifactorial and requires a better understanding to develop an effective medication.