From the Guidelines
The most recent and highest quality study recommends the use of Solriamfetol (Sunosi) and Pitolisant (Wakix) to treat excessive daytime sleepiness associated with obstructive sleep apnea, as they have been recently approved and show promise in addressing residual daytime sleepiness 1.
Key Points to Consider
- These medications work differently from traditional CPAP therapy by targeting wakefulness pathways in the brain rather than addressing airway obstruction directly.
- Solriamfetol is typically started at 75mg once daily in the morning and may be increased to 150mg daily, while Pitolisant begins at 8.9mg daily and can be titrated up to 35.6mg daily.
- It's essential to understand that these medications don't replace CPAP therapy but complement it by addressing residual daytime sleepiness.
- Another medication showing promise is Atomoxetine, which increases upper airway muscle activity during sleep.
- For optimal results, these medications should be used alongside primary treatments like CPAP, weight loss, and positional therapy.
Important Considerations
- Side effects may include headache, nausea, decreased appetite, and anxiety, so regular follow-up with a healthcare provider is essential to monitor effectiveness and adjust dosing as needed.
- The European Respiratory Society guideline on non-Cpap therapies for obstructive sleep apnea provides recommendations based on a systematic review of the literature and can be used to benchmark quality of care for people with OSA across Europe and to improve outcomes 1.
- Other medications such as carbonic anhydrase inhibitors and hypoglossal nerve stimulation may also be considered, but the evidence is less strong and more research is needed to fully understand their effectiveness 1.
From the Research
New Medication for Sleep Apnea
There are no specific mentions of new medications for sleep apnea in the provided studies. However, the studies discuss various treatment options for sleep apnea, including:
- Continuous positive airway pressure (CPAP) therapy, which is considered the gold standard treatment for obstructive sleep apnea (OSA) 2, 3, 4
- Oral appliances, which may be an option for patients with mild OSA who cannot tolerate CPAP 2
- Palatal surgery, which may decrease snoring but may not reduce the occurrence of sleep apnea 2
- Supplemental oxygen and drug therapy, which may have limited, adjunctive roles in the treatment of OSA 2
Treatment Approaches
The studies suggest that a multidisciplinary approach to the management of sleep apnea is important, including:
- Technical CPAP follow-up and management of comorbidities 3
- Multimodal non-invasive monitoring and longitudinal assessment of patient-reported outcomes 3
- A focus on long-term cardiometabolic health as part of managing CPAP-treated patients with OSA 3
- Troubleshooting of side effects and using supportive interventions to increase the probability of long-term adherence to CPAP therapy 4
Central Sleep Apnea
One study discusses the treatment of central sleep apnea, suggesting that modification of key components of neurochemical control may be a more effective approach than the current universal use of positive airway pressure 5. Another study examines the association between mixed sleep apnea and treatment-emergent central sleep apnea, finding that baseline mixed apnea in non-rapid eye movement sleep can predict the incidence of treatment-emergent central sleep apnea after initial CPAP 6.
Some key points to consider when managing sleep apnea include: