Pharmacologic Therapies for the treatment of OSA
Sleep Apnea Medications:
1. Anti-obesity drugs are being used frequently to assist in achievement of weight loss by modifying fat digestion and suppressing appetite.
2. The effect of these drugs with the primary focus on OSA has been studied in very few trials.
3. Many of these trials involved sibutramine, which has been withdrawn from the market and the existing trials yielded mixed results when OSA outcomes were measured.
4. Orlistat is a drug that inhibits pancreatic lipase, thereby decreasing dietary fat absorption. While this drug in conjunction with dietary modification was associated with an average of a 7-8 lb. weight loss after 1 year, many patients were not able to comply with the dietary restrictions. There is no good evidence that Orlistat is effective in treating OSA via weight loss.
5. Other drugs that suppress appetite include the serotonin agonists, sympathomimetics, anti-depressants, and anti-epileptic drugs. Their use is limited by frequent and serious side effects, short-term use, and regain of weight once they are discontinued.
6. Weight loss medications may be added to diet and exercise in the obese patient with BMI greater than 30, or BMI greater than 27 with comorbidities.
7. Down sides of the use of weight-loss medications include frequent side effects, short-term benefit, and lack of long -term safety.
8. The expected weight lost with these medications is modest and short-lived and thus must be combined with lifestyle changes as part of a comprehensive weight management program for a healthier life.