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Semin Respir Crit Care Med 2005; 26(1): 96-108
DOI: 10.1055/s-2005-864203
Copyright © 2005 by Thieme Medical Publishers, Inc., 333 Seventh Avenue, New York, NY 10001, USA.

Medical Treatment of Obstructive Sleep Apnea

Asher Qureshi1 , 2 , Teofilo L. Lee-Chiong3 , 4  Jr. 
  • 1Department of Pulmonary and Critical Care, St. Francis Hospital and Medical Center, Hartford, Connecticut
  • 2Department of Clinical Medicine, University of Connecticut, Farmington, Connecticut
  • 3National Jewish Medical and Research Center, Denver, Colorado
  • 4University of Colorado Health Sciences Center, Denver, Colorado
Further Information

Publication History

Publication Date:
22 February 2005 (online)

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ABSTRACT

A variety of treatment options are available for the treatment of obstructive sleep apnea in addition to positive pressure therapy and surgery. These modes of treatment might be employed in patients who cannot tolerate positive pressure therapy despite aggressive measures to improve compliance. These options include weight reduction, sleep hygiene, positional therapy, and oxygen therapy. Some of the options are still experimental and include pharyngeal muscle and hypoglossal nerve stimulators. A variety of pharmacological agents have also been used. The mechanisms by which these drugs improve sleep-disordered breathing include increasing ventilatory drive and upper airway muscle tone, reducing the amount of rapid eye movement (REM) sleep, and enhancing daytime wakefulness.

KEYWORDS

Obstructive sleep apnea - positional therapy - weight reduction - oxygen therapy - pharmacological treatment of sleep apnea

REFERENCES

  • 1 George C F, Millar T W, Kryger M H. Sleep apnea and body position during sleep.  Sleep. 1988;  11 90-99
    PubMedGoogle Scholar
  • 2 Cartwright R D. Effect of sleep position on sleep apnea severity.  Sleep. 1984;  7 110-114
    PubMedGoogle Scholar
  • 3 Jokic R, Klimaszewski A, Crossley M, Sridhar G, Fitzpatrick M F. Positional treatment vs continuous positive airway pressure in patients with positional bstructive sleep apnea syndrome.  Chest. 1999;  115 771-781
    CrossrefPubMedGoogle Scholar
  • 4 Fransson A M, Svenson B A, Isacsson G. The effect of posture and a mandibular protruding device on pharyngeal dimensions: a cephalometric study.  Sleep Breath. 2002;  6 55-68
    Article in Thieme ConnectPubMedGoogle Scholar
  • 5 Yoshida K. Influence of sleep posture on response to oral appliance therapy for sleep apnea syndrome.  Sleep. 2001;  24 538-544
    PubMedGoogle Scholar
  • 6 Bahammam A S, Tate R, Manfreda J, Kryger M H. Upper airway resistance syndrome: effect of nasal dilation, sleep stage, and sleep position.  Sleep. 1999;  22 592-598
    PubMedGoogle Scholar
  • 7 Neil A, Ignacio E, Shaharuddin N, Sajkov D. Upper body elevation improves upper airway stability but not indices of severity in obstructive sleep apnea syndrome.  Aust N Z J Med. 1998;  28 270
    PubMedGoogle Scholar
  • 8 Neill A M, Angus S M, Sajkov D, McEvoy R D. Effects of sleep posture on upper airway stability in patients with obstructive sleep apnea.  Am J Respir Crit Care Med. 1997;  155 199-204
    PubMedGoogle Scholar
  • 9 Penzel T, Moller M, Becker H F, Knaack L, Peter J H. Effect of sleep position and sleep stage on the collapsibility of the upper airways in patients with sleep apnea.  Sleep. 2001;  24 909-995
    PubMedGoogle Scholar
  • 10 Cartwright R, Ristanovic R, Diaz F, Caldarelli D, Alder G. A comparative study of treatments for positional sleep apnea.  Sleep. 1991;  14 546-552
    PubMedGoogle Scholar
  • 11 Cartwright R, Lloyd S, Lilie J, Kravitz H. Sleep position training as treatment for sleep apnea syndrome: a preliminary study.  Sleep. 1985;  8 87-94
    Google Scholar
  • 12 Katz I, Stradling J, Slutsky A S, Zamel N, Hoffstein V. Do patients with obstructive sleep apnea have thick necks?.  Am Rev Respir Dis. 1990;  141 1228-1231
    CrossrefPubMedGoogle Scholar
  • 13 Ryan C F, Love L L. Mechanical properties of the velopharynx in obese patients with obstructive sleep apnea.  Am J Respir Crit Care Med. 1996;  154 806-812
    PubMedGoogle Scholar
  • 14 Schwab R, Gefter W, Hoffman E, Gupta K B, Pack A I. Dynamic upper airway imaging during awake respiration in normal subjects and patients with sleep disordered breathing.  Am Rev Respir Dis. 1993;  148 1385-1400
    PubMedGoogle Scholar
  • 15 Horner R L, Mohiaddin R H, Lowell D G et al.. Sites and sizes of fat deposits around the pharynx in obese patients with obstructive sleep apnoea and weight matched controls.  Eur Respir J. 1989;  2 613-622
    PubMedGoogle Scholar
  • 16 Suratt P, McTier R, Wilhoit S C. Collapsibility of the nasopharyngeal airway in obstructive sleep apnea.  Am Rev Respir Dis. 1985;  132 967-971
    PubMedGoogle Scholar
  • 17 Schwartz A R, Gold A R, Schubert N et al.. Effect of weight loss on upper airway collapsibility in obstructive sleep apnea.  Am Rev Respir Dis. 1991;  144 494-498
    PubMedGoogle Scholar
  • 18 Browman C P, Sampson M G, Yolles S F et al.. Obstructive sleep apnea and body weight.  Chest. 1984;  85 435-436
    CrossrefPubMedGoogle Scholar
  • 19 Smith P L, Gold A R, Meyers D A, Haponik E F, Bleecker E R. Weight loss in mildly to moderately obese patients with obstructive sleep apnea.  Ann Intern Med. 1985;  103 850-855
    PubMedGoogle Scholar
  • 20 Peppard P E, Young T, Palta M, Dempsey J, Skatrud J. Longitudinal study of moderate weight change and sleep disordered breathing.  JAMA. 2000;  284 3015-3021
    CrossrefPubMedGoogle Scholar
  • 21 Lojander J, Mustajoki P, Ronka S, Mecklin P, Maasilta P. A nurse-managed weight reduction programme for obstructive sleep apnoea syndrome.  J Intern Med. 1998;  244 251-255
    CrossrefPubMedGoogle Scholar
  • 22 Pasquali R, Colella P, Cirignotta F et al.. Treatment of obese patients with obstructive sleep apnea syndrome(OSAS): effect of weight loss and interference of otorhinolaryngoiatric pathology.  Int J Obes. 1990;  14 207-217
    PubMedGoogle Scholar
  • 23 Suratt P M, McTier R E, Findley L J, Pohl S L, Wilhoit S C. Effect of very-low calorie diets with weight loss on obstructive sleep apnea.  Am J Clin Nutr. 1992;  56(suppl) 182S-184S
    PubMedGoogle Scholar
  • 24 Kansanen M, Vanninen E, Tuunainen A et al.. The effect of very low-calorie diet-induced weight loss on the severity of obstructive sleep apnoea and autonomic nervous function in obese patients with obstructive sleep apnoea syndrome.  Clin Physiol. 1998;  18 377-385
    CrossrefPubMedGoogle Scholar
  • 25 Sugerman H J, Fairman R P, Sood R K, Engle K, Wolfe L, Kellum J M. Long-term effects of gastric surgery for treating respiratory insufficiency of obesity.  Am J Clin Nutr. 1992;  55 597S-601S
    PubMedGoogle Scholar
  • 26 Harman E M, Wynne J W, Block A J. The effect of weight loss on sleep disordered breathing and oxygen desaturation in morbidly obese men.  Chest. 1982;  82 291-294
    PubMedGoogle Scholar
  • 27 Charuzi I, Ovnat A, Peiser J, Saltz H, Weitzman S, Lavie P. The effect of surgical weight reduction on sleep quality in obesity-related sleep apnea syndrome.  Surgery. 1985;  97 535-538
    PubMedGoogle Scholar
  • 28 Scheuller M, Weider D. Bariatric surgery for treatment of sleep apnea syndrome in 15 morbidly obese patients: long-term results.  Otolaryngol Head Neck Surg. 2001;  125 299-302
    Google Scholar
  • 29 NIH Technology Assessment Conference Panel . Methods for voluntary weight loss and control.  Ann Intern Med. 1993;  119 764-770
    PubMedGoogle Scholar
  • 30 Garner D, Wooley S. Confronting the failure of behavioural and dietary treatment for obesity.  Clin Psychol Rev. 1991;  11 729-780
    PubMedGoogle Scholar
  • 31 Sampol G, Munoz X, Sagales M T et al.. Long-term efficacy of dietary weight loss in sleep apnoea/hypopnoea syndrome.  Eur Respir J. 1998;  12 1156-1159
    CrossrefPubMedGoogle Scholar
  • 32 Pillar G, Peled R, Lavie P. Recurrence of sleep apnea without concomitant weight increase 7.5 years after weight reduction surgery.  Chest. 1994;  106 1702-1704
    Google Scholar
  • 33 Loube D I, Loube A A, Mitler M M. Weight loss for obstructive sleep apnea: the optimal therapy for obese patients.  J Am Diet Assoc. 1994;  94 1291-1295
    CrossrefPubMedGoogle Scholar
  • 34 Stradling J, Roberts D, Wilson A, Lovelock F. Controlled trial of hypnotherapy for weight loss in patients with obstructive sleep apnoea.  Int J Obes Relat Metab Disord. 1998;  22 278-281
    CrossrefPubMedGoogle Scholar
  • 35 Mayos M, Hernandez Plaza L, Farre A, Mota S, Sanchis J. The effect of nocturnal oxygen therapy in patients with sleep apnea syndrome and chronic airflow limitation.  Arch Bronconeumol. 2001;  37 65-68
    PubMedGoogle Scholar
  • 36 Marcus C L, Carroll J L, Bamford O, Pyzik P, Loughlin G M. Supplemental oxygen during sleep in children with sleep-disordered breathing.  Am J Respir Crit Care Med. 1995;  152(4 Pt 1) 1297-1301
    PubMedGoogle Scholar
  • 37 Phillips B A, Schmitt F A, Berry D T, Lamb D G, Amin M, Cook Y R. Treatment of obstructive sleep apnea. A preliminary report comparing nasal CPAP to nasal oxygen in patients with mild OSA.  Chest. 1990;  98 325-330
    PubMedGoogle Scholar
  • 38 Staniforth A D, Kinnear W J, Starling R, Hetmanski D J, Cowley A J. Effect of oxygen on sleep quality, cognitive function and sympathetic activity in patients with chronic heart failure and Cheyne-Stokes respiration.  Eur Heart J. 1998;  19 922-928
    CrossrefPubMedGoogle Scholar
  • 39 Gold A R, Schwartz A R, Bleecker E R, Smith P L. The effect of chronic nocturnal oxygen administration upon sleep apnea.  Am Rev Respir Dis. 1986;  134 925-929
    PubMedGoogle Scholar
  • 40 Marrone O, Bellia V, Pieri D, Salvaggio A, Bonsignore G. Acute effects of oxygen administration on transmural pulmonary artery pressure in obstructive sleep apnea.  Chest. 1992;  101 1023-1027
    PubMedGoogle Scholar
  • 41 Chauncey J B, Aldrich M S. Preliminary findings in the treatment of obstructive sleep apnea with transtracheal oxygen.  Sleep. 1990;  13 167-174
    PubMedGoogle Scholar
  • 42 Finnimore A J, Roebuck M, Sajkov D, McEvoy R D. The effects of the GABA agonist, baclofen, on sleep and breathing.  Eur Respir J. 1995;  8 230-234
    PubMedGoogle Scholar
  • 43 Dolly F R, Block A J. Effect of flurazepam on sleep-disordered breathing and nocturnal oxygen desaturation in asymptomatic subjects.  Am J Med. 1982;  73 239-243
    CrossrefPubMedGoogle Scholar
  • 44 Ancoli-Israel S, Kripke D F, Zorick F, Roth T. Effects of a single dose of flurazepam on the sleep of healthy volunteers.  Arzneimittelforschung. 1984;  34 99-100
    PubMedGoogle Scholar
  • 45 Hoijer U, Hedner J, Ejnell H, Grunstein R, Odelberg E, Elam M. Nitrazepam in patients with sleep apnoea: a double-blind placebo-controlled study.  Eur Respir J. 1994;  7 2011-2015
    PubMedGoogle Scholar
  • 46 Camacho M E, Morin C M. The effect of temazepam on respiration in elderly insomniacs with mild sleep apnea.  Sleep. 1995;  18 644-645
    PubMedGoogle Scholar
  • 47 Berry R B, Kouchi K, Bower J, Prosise G, Light R W. Triazolam in patients with obstructive sleep apnea.  Am J Respir Crit Care Med. 1995;  151(2 Pt 1) 450-454
    PubMedGoogle Scholar
  • 48 Clyburn P A, Rosen M, Vickers M D. Comparison of the respiratory effects of I.V. infusions of morphine and regional analgesia by extradural block. BJA.  Br J Anaesth. 1990;  64 446-449
    PubMedGoogle Scholar
  • 49 Robinson R W, Zwillich C W, Bixler E O, Cadieux R J, Kales A, White D P. Effects of oral narcotics on sleep-disordered breathing in healthy adults.  Chest. 1987;  91 197-203
    CrossrefPubMedGoogle Scholar
  • 50 Steens R D, Pouliot Z, Millar T W, Kryger M H, George C F. Effects of zolpidem and triazolam on sleep and respiration in mild to moderate chronic obstructive pulmonary disease.  Sleep. 1993;  16 318-326
    PubMedGoogle Scholar
  • 51 Lofaso F, Goldenberg F, Thebault C, Janus C, Harf A. Effect of zopiclone on sleep, night-time ventilation, and daytime vigilance in upper airway resistance syndrome.  Eur Respir J. 1997;  10 2573-2577
    CrossrefPubMedGoogle Scholar
  • 52 Tojima H, Kunitomo F, Kimura H, Tatsumi K, Kuriyama T, Honda Y. Effects of acetazolamide in patients with the sleep apnoea syndrome.  Thorax. 1988;  43 113-119
    PubMedGoogle Scholar
  • 53 Whyte K F, Gould G A, Airlie M A, Shapiro C M, Douglas N J. Role of protriptyline and acetazolamide in the sleep apnea/hypopnea syndrome.  Sleep. 1988;  11 463-472
    PubMedGoogle Scholar
  • 54 Sakamoto T, Nakazawa Y, Hashizume Y et al.. Effects of acetazolamide on the sleep apnea syndrome and its therapeutic mechanism.  Psychiatry Clin Neurosci. 1995;  49 59-64
    PubMedGoogle Scholar
  • 55 Inoue Y, Takata K, Sakamoto I, Hazama H, Kawahara R. Clinical efficacy and indication of acetazolamide treatment on sleep apnea syndrome.  Psychiatry Clin Neurosci. 1999;  53 321-322
    CrossrefPubMedGoogle Scholar
  • 56 Guilleminault C, Silvestri R, Mondini S, Coburn S. Aging and sleep apnea: action of benzodiazepine, acetazolamide, alcohol, and sleep deprivation in a healthy elderly group.  J Gerontol. 1984;  39 655-661
    PubMedGoogle Scholar
  • 57 Mangin P, Krieger J, Kurtz D. Effect of oral almitrine on the sleep apnea syndrome.  Rev Fr Mal Respir. 1983;  11 899-906
    PubMedGoogle Scholar
  • 58 Marrone O, Milone F, Coppola P et al.. Effects of almitrine bismesylate on nocturnal hypoxemia in patients with chronic bronchitis and obesity.  Eur J Respir Dis Suppl. 1986;  146 641-648
    PubMedGoogle Scholar
  • 59 Block A J, Wynne J W, Boysen P G, Lindsey S, Martin C, Cantor B. Menopause, medroxyprogesterone and breathing during sleep.  Am J Med. 1981;  70 506-510
    CrossrefPubMedGoogle Scholar
  • 60 Strohl K P, Hensley M J, Saunders N A, Scharf S M, Brown R, Ingram Jr R H. Progesterone administration and progressive sleep apneas.  JAMA. 1981;  245 1230-1232
    CrossrefPubMedGoogle Scholar
  • 61 Kimura H, Tatsumi K, Kunitomo F et al.. Progesterone therapy for sleep apnea syndrome evaluated by occlusion pressure responses to exogenous loading.  Am Rev Respir Dis. 1989;  139 1198-1206
    PubMedGoogle Scholar
  • 62 Ohshima H. Medroxyprogesterone acetate and sleep apnea.  Jpn J Psychiatry Neurol. 1987;  41 645-650
    PubMedGoogle Scholar
  • 63 Watanabe T, Mikami A, Motonishi M et al.. Two cases of sleep-disordered breathing in climacteric.  Psychiatry Clin Neurosci. 1998;  52 231-232
    PubMedGoogle Scholar
  • 64 Rajagopal K R, Abbrecht P H, Jabbari B. Effects of medroxyprogesterone acetate in obstructive sleep apnea.  Chest. 1986;  90 815-821
    PubMedGoogle Scholar
  • 65 Cook W R, Benich J J, Wooten S A. Indices of severity of obstructive sleep apnea syndrome do not change during medroxyprogesterone acetate therapy.  Chest. 1989;  96 262-266
    PubMedGoogle Scholar
  • 66 Dolly F R, Block A J. Medroxyprogesterone acetate and COPD. Effect on breathing and oxygenation in sleeping and awake patients.  Chest. 1983;  84 394-398
    PubMedGoogle Scholar
  • 67 Saaresranta T, Polo-Kantola P, Rauhala E, Polo O. Medroxyprogesterone in postmenopausal females with partial upper airway obstruction during sleep.  Eur Respir J. 2001;  18 989-995
    CrossrefPubMedGoogle Scholar
  • 68 Keefe D L, Watson R, Naftolin F. Hormone replacement therapy may alleviate sleep apnea in menopausal women: a pilot study.  Menopause. 1999;  6 196-200
    CrossrefPubMedGoogle Scholar
  • 69 Pickett C K, Regensteiner J G, Woodard W D, Hagerman D D, Weil J V, Moore L G. Progestin and estrogen reduce sleep-disordered breathing in postmenopausal women.  J Appl Physiol. 1989;  66 1656-1661
    PubMedGoogle Scholar
  • 70 Cistulli P A, Barnes D J, Grunstein R R, Sullivan C E. Effect of short-term hormone replacement in the treatment of obstructive sleep apnoea in postmenopausal women.  Thorax. 1994;  49 699-702
    CrossrefPubMedGoogle Scholar
  • 71 Krieger J, Mangin P, Kurtz D. Sleep apnea synrome: effects of chlorimipramine in subjects with stable body weight.  Rev Electroencephalogr Neurophysiol Clin. 1979;  9 250-257
    PubMedGoogle Scholar
  • 72 Esnault-Lavandier S, Mabin D. The effects of clomipramine on diurnal sleepiness and respiratory parameters in a a case of Prader-Willi syndrome.  Neurophysiol Clin. 1998;  28 521-525
    PubMedGoogle Scholar
  • 73 Rubin A H, Alroy G G, Peled R, Lavie P. Preliminary clinical experience with imipramine HCl in the treatment of sleep apnea syndrome.  Eur Neurol. 1986;  25 81-85
    PubMedGoogle Scholar
  • 74 Sunderram J, Parisi R A, Strobel R J. Serotonergic stimulation of the genioglossus and the response to nasal continuous positive airway pressure.  Am J Respir Crit Care Med. 2000;  162(3 Pt 1) 925-929
    PubMedGoogle Scholar
  • 75 Berry R B, Yamaura E M, Gill K, Reist C. Acute effects of paroxetine on genioglossus activity in obstructive sleep apnea.  Sleep. 1999;  22 1087-1092
    PubMedGoogle Scholar
  • 76 Kraiczi H, Hedner J, Dahlof P, Ejnell H, Carlson J. Effect of serotonin uptake inhibition on breathing during sleep and daytime symptoms in obstructive sleep apnea.  Sleep. 1999;  22 61-67
    PubMedGoogle Scholar
  • 77 Brownell L G, West P, Sweatman P, Acres J C, Kryger M H. Protriptyline in obstructive sleep apnea: a double-blind trial.  N Engl J Med. 1982;  307 1037-1042
    PubMedGoogle Scholar
  • 78 Brownell L G, Perez-Padilla R, West P, Kryger M H. The role of protriptyline in obstructive sleep apnea.  Bull Eur Physiopathol Respir. 1983;  19 621-624
    PubMedGoogle Scholar
  • 79 Hanzel D A, Proia N G, Hudgel D W. Response of obstructive sleep apnea to fluoxetine and protriptyline.  Chest. 1991;  100 416-421
    PubMedGoogle Scholar
  • 80 Whyte K F, Gould G A, Airlie M A, Shapiro C M, Douglas N J. Role of protriptyline and acetazolamide in the sleep apnea/hypopnea syndrome.  Sleep. 1988;  11 463-472
    PubMedGoogle Scholar
  • 81 Conway W A, Zorick F, Piccione P, Roth T. Protriptyline in the treatment of sleep apnoea.  Thorax. 1982;  37 49-53
    PubMedGoogle Scholar
  • 82 Smith P L, Haponik E F, Allen R P, Bleecker E R. The effects of protriptyline in sleep-disordered breathing.  Am Rev Respir Dis. 1983;  127 8-13
    PubMedGoogle Scholar
  • 83 Hanzel D A, Proia N G, Hudgel D W. Response of obstructive sleep apnea to fluoxetine and protriptyline.  Chest. 1991;  100 416-421
    PubMedGoogle Scholar
  • 84 Veasey S C, Fenik P, Panckeri K, Pack A I, Hendricks J C. The effects of trazodone with L-tryptophan on sleep-disordered breathing in the English bulldog.  Am J Respir Crit Care Med. 1999;  160(5 Pt 1) 1659-1667
    PubMedGoogle Scholar
  • 85 Salazar-Grueso E F, Rosenberg R S, Roos R P. Sleep apnea in olivopontocerebellar degeneration: treatment with trazodone.  Ann Neurol. 1988;  23 399-401
    CrossrefPubMedGoogle Scholar
  • 86 Chiang C H, Tang Y C, Wang S E, Hwang J C. Changes in phrenic, hypoglossal and recurrent laryngeal nerve activities after intravenous infusions of aminophylline in cats.  Eur Respir J. 1995;  8 632-636
    PubMedGoogle Scholar
  • 87 Schafer H H, Grieger E, Heitmann J et al.. Long-term theophylline therapy in sleep apnea-follow-up over a period of 12 months.  Pneumologie. 1993;  47(Suppl 4) 741-746
    PubMedGoogle Scholar
  • 88 Meissner P, Dorow P, Thalhofer S, Heinemann S. Theophylline acceptance in long-term therapy of patients with obstructive sleep related respiratory disorder.  Pneumologie. 1995;  49(Suppl 1) 187-189
    PubMedGoogle Scholar
  • 89 Hein H, Kirsten D, Jugert C, Magnussen H. Theophylline in therapy of obstructive sleep apnea?.  Pneumologie. 1993;  47(Suppl 4) 750-753
    PubMedGoogle Scholar
  • 90 Guilleminault C, Hayes B. Naloxone, theophylline, bromocriptine, and obstructive sleep apnea. Negative results.  Bull Eur Physiopathol Respir. 1983;  19 632-634
    PubMedGoogle Scholar
  • 91 Espinoza H, Antic R, Thornton A T, McEvoy R D. The effects of aminophylline on sleep and sleep-disordered breathing in patients with obstructive sleep apnea syndrome.  Am Rev Respir Dis. 1987;  136 80-84
    PubMedGoogle Scholar
  • 92 Oberndorfer S, Saletu B, Gruber G et al.. Theophylline in snoring and sleep-related breathing disorders: sleep laboratory investigations on subjective and objective sleep and awakening quality.  Methods Find Exp Clin Pharmacol. 2000;  22 237-245
    CrossrefPubMedGoogle Scholar
  • 93 Tschida U, Winkler A. Efficiency of continuous positive airway pressure versus theophylline therapy in sleep apnea: comparative sleep laboratory studies on objective and subjective sleep and awakening quality.  Neuropsychobiology. 1999;  39 151-159
    PubMedGoogle Scholar
  • 94 Kempf P, Mossinger B, Muller B, Kirchheiner T, Ruhle K H. Comparative studies on the effect of nasal CPAP, theophylline and oxygen in patients with sleep apnea syndrome.  Pneumologie. 1991;  45(Suppl 1) 279-282
    PubMedGoogle Scholar
  • 95 Di Martino E, Saadi R, Emmerling O, Werner E. Drug therapy of sleep apnea syndromes: results of short-term treatment with theophylline.  Laryngorhinootologie. 1999;  78 120-124
    PubMedGoogle Scholar
  • 96 Mulloy E, McNicholas W T. Theophylline in obstructive sleep apnea. A double-blind evaluation.  Chest. 1992;  101 753-757
    PubMedGoogle Scholar
  • 97 Berry R B, Desa M M, Branum J P, Light R W. Effect of theophylline on sleep and sleep-disordered breathing in patients with chronic obstructive pulmonary disease.  Am Rev Respir Dis. 1991;  143 245-250
    PubMedGoogle Scholar
  • 98 Teramoto S, Ohga E, Katayama H et al.. Effects of thyroid hormone replacement therapy on nocturnal apnea in elderly patients with hypothyroidism.  Nihon Kokyuki Gakkai Zasshi. 1998;  36 590-594
    PubMedGoogle Scholar
  • 99 Bai Y. Primary hypothyroidism with obstructive sleep apnea syndrome.  Zhongguo Yi Xue Ke Xue Yuan Xue Bao. 1992;  14 267-272
    PubMedGoogle Scholar
  • 100 Ziemer D C, Dunlap D B. Relief of sleep apnea in acromegaly by bromocriptine.  Am J Med Sci. 1988;  295 49-51
    PubMedGoogle Scholar
  • 101 Guilleminault C, Hayes B. Naloxone, theophylline, bromocriptine, and obstructive sleep apnea: negative results.  Bull Eur Physiopathol Respir. 1983;  19 632-634
    PubMedGoogle Scholar
  • 102 Davis J M, Zinman R, Aranda J V. Use of caffeine in the treatment of apnea associated with the Arnold-Chiari malformation.  Dev Pharmacol Ther. 1989;  12 70-73
    PubMedGoogle Scholar
  • 103 Carley D W, Paviovic S, Janelidze M, Radulovacki M. Functional role for cannabinoids in respiratory stability during sleep.  Sleep. 2002;  25 391-398
    PubMedGoogle Scholar
  • 104 Mayer J, Peter J H. First experience with cilazapril in the treatment of sleep apnoea-related hypertension.  Drugs. 1991;  41(Suppl 1) 37-47
    PubMedGoogle Scholar
  • 105 Peter J H, Gassel W, Mayer J et al.. Effect of cilazapril on hypertension, sleep, and apnea.  Am J Med. 1989;  87(Suppl 6B) 72S-78S
    CrossrefPubMedGoogle Scholar
  • 106 Grote L, Wutkewicz K, Knaack L, Ploch T, Hedner J, Peter J H. Association between blood pressure reduction with antihypertensive treatment and sleep apnea activity.  Am J Hypertens. 2000;  13 1280-1287
    CrossrefPubMedGoogle Scholar
  • 107 Issa F G. Effect of clonidine in obstructive sleep apnea.  Am Rev Respir Dis. 1992;  145(2 Pt 1) 435-439
    PubMedGoogle Scholar
  • 108 Osanai S, Akiba Y, Fujiuchi S et al.. Depression of peripheral chemosensitivity by a dopaminergic mechanism in patients with obstructive sleep apnoea syndrome.  Eur Respir J. 1999;  13 418-423
    CrossrefPubMedGoogle Scholar
  • 109 Suratt P M, Wilhoit S C, Brown E D, Findley L J. Effect of doxapram on obstructive sleep apnea.  Bull Eur Physiopathol Respir. 1986;  22 127-131
    PubMedGoogle Scholar
  • 110 Schmidt H S. L-tryptophan in the treatment of impaired respiration in sleep.  Bull Eur Physiopathol Respir. 1983;  19 625-629
    PubMedGoogle Scholar
  • 111 Pack A I, Black J E, Schwartz J R, Matheson J K. Modafinil as adjunct therapy for daytime sleepiness in obstructive sleep apnea.  Am J Respir Crit Care Med.. 2001;  64 1675-1681
    PubMedGoogle Scholar
  • 112 Arnulf I, Homeyer P, Garma L, Whitelaw W A, Derenne J P. Modafinil in obstructive sleep apnea-hypopnea syndrome: a pilot study in 6 patients.  Respiration. 1997;  64 159-161
    PubMedGoogle Scholar
  • 113 Kingshott R N, Vennelle M, Coleman E L, Engleman H M, Mackay T W, Douglas N J. Randomized, double-blind, placebo-controlled crossover trial of modafinil in the treatment of residual excessive daytime sleepiness in the sleep apnea/hypopnea syndrome.  Am J Respir Crit Care Med. 2001;  163 918-923
    PubMedGoogle Scholar
  • 114 Guilleminault C, Hayes B. Naloxone, theophylline, bromocriptine, and obstructive sleep apnea. Negative results.  Bull Eur Physiopathol Respir. 1983;  19 632-634
    PubMedGoogle Scholar
  • 115 Haidmayer R, Kerbl R, Meyer U, Kerschhaggl P, Kurz R, Kenner T. Effects of naloxone on apnoea duration during sleep in infants at risk for SIDS.  Eur J Pediatr. 1986;  145 357-360
    CrossrefPubMedGoogle Scholar
  • 116 Ferber C, Sanchez P, Lemoine P, Mouret J. Efficacy of the treatment of sleep apnea using naltrexone: a clinical, polygraphic and gasometric study.  C R Acad Sci III. 1988;  307 695-700
    PubMedGoogle Scholar
  • 117 Ferber C, Duclaux R, Mouret J. Naltrexone improves blood gas patterns in obstructive sleep apnoea syndrome through its influence on sleep.  J Sleep Res. 1993;  2 149-155
    PubMedGoogle Scholar
  • 118 Davila D G, Hurt R D, Offord K P, Harris C D, Shepard Jr J W. Acute effects of transdermal nicotine on sleep architecture, snoring, and sleep-disordered breathing in nonsmokers.  Am J Respir Crit Care Med. 1994;  150 469-474
    CrossrefPubMedGoogle Scholar
  • 119 Gothe B, Strohl K P, Levin S, Cherniack N S. Nicotine: a different approach to treatment of obstructive sleep apnea.  Chest. 1985;  87 11-17
    PubMedGoogle Scholar
  • 120 Wirth J A. Organic psychosyndrome and sleep apnea: transdermal nicotine-a new therapy concept?.  Pneumologie. 1995;  49(Suppl 1) 183-184
    PubMedGoogle Scholar
  • 121 Hein H, Kirsten D, Jugert C, Magnussen H. Nicotine as therapy of obstructive sleep apnea?.  Pneumologie. 1995;  49(Suppl 1) 185-186
    PubMedGoogle Scholar
  • 122 Veasey S C, Chachkes J, Fenik P, Hendricks J C. The effects of ondansetron on sleep-disordered breathing in the English bulldog.  Sleep. 2001;  24 155-160
    PubMedGoogle Scholar
  • 123 Hedner J, Grunstein R, Eriksson B, Ejnell H. A double-blind, randomized trial of sabeluzole: a putative glutamate antagonist in obstructive sleep apnea.  Sleep. 1996;  19 287-289
    PubMedGoogle Scholar
  • 124 Ip M S, Tan K C, Peh W C, Lam K S. Effect of Sandostatin LAR on sleep apnoea in acromegaly: correlation with computerized tomographic cephalometry and hormonal activity.  Clin Endocrinol (Oxf). 2001;  55 477-483
    CrossrefPubMedGoogle Scholar
  • 125 Esnault S, Merceur C, Kerlan V et al.. Long-term effects of treatment with SMS 201-995 on sleep apnea syndrome associated with acromegaly.  Neurophysiol Clin. 1989;  19 367-372
    PubMedGoogle Scholar
  • 126 Grunstein R R, Ho K K, Sullivan C E. Effect of octreotide, a somatostatin analog, on sleep apnea in patients with acromegaly.  Ann Intern Med. 1994;  121 478-483
    PubMedGoogle Scholar
  • 127 Brouillette R T, Manoukian J J, Ducharme F M et al.. Efficacy of fluticasone nasal spray for pediatric obstructive sleep apnea.  J Pediatr. 2001;  138 838-844
    CrossrefPubMedGoogle Scholar
  • 128 Guilleminault C, Powell N, Bowman B, Stoohs R. The effect of electrical stimulation on obstructive sleep apnea.  Chest. 1995;  107 67-73
    PubMedGoogle Scholar
  • 129 Goding Jr G S, Eisele D W, Testerman R, Smith P L, Roertgen K, Schwartz A R. Relief of upper airway obstruction with hypoglossal nerve stimulation in the canine.  Laryngoscope. 1998;  108 162-169
    PubMedGoogle Scholar
  • 130 Eisele D W, Smith P L, Alam D S, Schwartz A R. Direct hypoglossal nerve stimulation in obstructive sleep apnea.  Arch Otolaryngol Head Neck Surg. 1997;  123 57-61
    PubMedGoogle Scholar
  • 131 Hoijer U, Ejnell H, Hedner J, Petruson B, Eng L B. The effects of nasal dilation on snoring and obstructive sleep apnea.  Arch Otolaryngol Head Neck Surg. 1992;  118 281-284
    PubMedGoogle Scholar

Asher QureshiM.B.B.S. 

Sleep Disorders Center, Department of Pulmonary and Critical Care

St. Francis Hospital and Medical Center

114 Woodland St., Hartford, CT 06015

Email: aqureshi@stfranciscare.org

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