Obstructive sleep apnea (OSA) is unique among neurologic conditions because there is no medication that is considered first-line treatment. Instead, pharmacotherapy is considered adjunctive (see also Chapter 13) to more established treatments such as, continuous positive airway pressure (CPAP) or bilevel positive airway pressure (BPAP), an oral appliance (1), or a surgical intervention such as uvulopalatopharyngoplasty (2,3). With this in mind, it is perhaps even more important to consider how an individual's routine medications impact OSA. Individuals with sleep apnea frequently take medications to manage coexisting conditions such as hypertension, diabetes, coronary artery disease, congestive heart failure, pain, a mood disorder, or nocturnal insomnia (2,4). Any medication with significant sedating or central nervous system depressant properties, including benzodiazepines and opioids can interfere with the mini-arousals necessary to stimulate breathing and maintain an intact airway in persons with OSA (5,6). Interestingly, the use of antihypertensive or antidepressant medication is a marker for increased risk of OSA, particularly if an individual is prescribed both antihypertensives and antide-pressants and if their age is between 20 and 59 years old (7).
This chapter will review the literature regarding medications that improve OSA and medications that worsen OSA. Guidelines for the safe and effective use of medications for individuals with OSA and coexisting conditions will also be presented.
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