Pharmacological Management of Sleep-Disordered Breathing

Research output: Chapter in Book/Report/Conference proceedingChapterpeer-review

Abstract

First-line therapy for sleep-disordered breathing (SDB) relies on device treatments that are often poorly tolerated or not sufficiently effective. However, with increased knowledge of the pathophysiology of SDB, potential pharmacological targets have emerged. Obstructive sleep apnea (OSA) is characterized by four key endotypes: (1) impaired upper airway anatomy; (2) ineffective upper airway dilator muscle function; (3) low respiratory arousal threshold; and (4) unstable breathing control (high loop gain). Pharmacotherapies that target these endotypes or "treatable traits" have considerable therapeutic potential, particularly those that can improve upper airway dilator muscle function. Central sleep apnea (CSA) may be idiopathic, occur in response to high altitude, or be caused by underlying medical conditions including heart failure, stroke, and pulmonary hypertension and can overlap with OSA. In research studies, steroids, respiratory stimulants, sedatives, supplemental oxygen, and CO2 can reduce CSA severity and show promise as potential pharmacological treatments for SDB. However, further development and testing is required, including via larger scale and longer-term, randomized clinical trials to establish safety and efficacy outcomes prior to clinical use. This chapter focuses on the potential to use knowledge of the endotypic traits to target existing and emerging pharmacotherapies for SDB.
Original languageEnglish
Title of host publicationControl of Breathing during Sleep
Subtitle of host publicationBench to Bedside
EditorsSusmita Chowdhuri, M Safwan Badr, James A. Rowley
Place of PublicationBoca Raton, FL
PublisherCRC Press/Balkema
Chapter18
Pages221-232
Number of pages12
Volume1
ISBN (Electronic)978-1-003-00063-1
ISBN (Print)978-0-367-55625-9, 978-0-367-43011-5
DOIs
Publication statusPublished - 2023

Keywords

  • Sleep disorders
  • Sleep health
  • Sleep-disordered breathing
  • Pharmacological intervention

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