Each week we will aim to bring out a concise email that provides 4-5 key pieces of information addressing a specific issue in clinical therapeutics.
This week: Medications and obstructive sleep apnoea (OSA)
Sleep apnoea is a relatively common disorder involving pauses in breathing or shallow breaths during sleep. The pauses can last from a few seconds to over a minute, and can occur 30 times or more an hour. After the apnoeic episode, normal breathing then starts again, sometimes with a loud snort or choking sound.The person moves out of deep sleep and into light sleep, and the quality of your sleep is poor, causing daytime tiredness. However, sleep apnea is also associated with serious problems such high blood pressure and heart disease. The most common form is obstructive sleep apnea, where the airway collapses or becomes blocked during sleep.
- OSA can be managed in a variety of ways, most of which do not involve the use of medications. Weight loss and smoking cessation may be all that is needed in some cases. For people with severe allergy/hayfever, non-sedating antihistamines or intranasal steroids may assist, although in many cases a mechanical treatment delivered by a special machine is required – this is called Continuous Positive Airways Pressure (CPAP) – a topic beyond the scope of this discussion.
- Some medications may cause a deterioration of OSA – the most frequently implicated are drugs with central sedative actions. These include benzodiazepines, especially long-acting agents such as diazepam, nitrazepam and clonazepam, as well as some antipsychotics and antidepressants.
- Opioid agents such as morphine, oxycodone, fentanyl and others may also exacerbate or cause OSA. New/severe snoring, and periods of apnoea after the initiation of opioids or increased dose are warning signs that should trigger more detailed medical assessment.
Please consider these issues when preparing or interpreting RMMR reports or education sessions. Contributions of content or suggested topics are welcome and should be sent directly to firstname.lastname@example.org.