All interventions to improve tolerance of continuous positive airway pressure (CPAP) should be attempted prior to deciding that treatment has failed. CPAP is considered the gold standard of therapy for OSA and can usually reverse this condition quickly with the appropriate titration of devices.
Pharmacologic therapy is not part of primary treatment. No clinically useful drug therapy is currently available, except in certain cases of excessive sleepiness remaining after apparently successful treatment. In such cases, modafinil can be used at doses of 200-400 mg/d. (Armodafinil, the R-enantiomer of modafinil, has also been FDA approved for use in these patients.) In addition, solriamfetol, a dopamine/norepinephrine reuptake inhibitor (DNRI), received FDA approval in 2019 to improve wakefulness in patients with excessive daytime sleepiness who have OSA.
Patients in whom noninvasive medical therapy (eg, CPAP, OAs) fails should be offered surgical options. Patients should be made aware of the success rates for each surgical procedure. They should be informed that they might require more than one surgical procedure, some fairly extensive, to cure OSA. Refer patients only to centers that have personnel experienced in these special surgical techniques.
For more on the treatment of OSA, read here.
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Cite this: Zab Mosenifar. Fast Five Quiz: Obstructive Sleep Apnea Key Aspects - Medscape - Nov 21, 2019.
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