Central Sleep Apnea Syndromes Medication

Updated: Oct 10, 2017
  • Author: Kendra Becker, MD, MPH; Chief Editor: Zab Mosenifar, MD, FACP, FCCP  more...
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Medication

Medication SummaryAcetazolamide (Diamox)TheophyllineSedative hypnotics

Due to the heterogeneity of the central sleep apnea syndromes, different medications have been used under different circumstances. No single medication can be considered a drug of choice. [1] Several different medications aimed at improving central sleep apnea include acetazolamide, theophylline, and sedative-hypnotic agents.

Acetazolamide is a carbonic anhydrase inhibitor that causes bicarbaturia and metabolic acidosis, which presumably shifts the apneic threshold of PaCO2 to a lower level. It has been shown to be effective therapy in primary central sleep apnea and CSB in patients with heart failure and in the treatment of high-altitude periodic breathing.

This agent has been studied in patients with heart failure and was found to be effective in attenuating CSB. [41] It may also be effective for high-altitude periodic breathing.

These agents have been used successfully in treating nonhypercapnic central sleep apnea. Temazepam and zolpidem have been shown to be effective under these circumstances and are believed to work by consolidating the sleep pattern, thus minimizing the instability in ventilation induced by sleep-wake transitions. A case series showed zolpidem reduced central apneas, and the overall apnea-hypopnea index, without worsening obstructive events. [42]

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Carbonic Anhydrase Inhibitor

Class Summary

These agents are used to induce metabolic acidosis and increase baseline ventilation.

Acetazolamide (Diamox)

Acetazolamide is a carbonic anhydrase inhibitor for acclimatization to altitude in high-altitude cerebral edema (HACE) and acute mountain sickness (AMS). It helps prevent AMS in forced rapid ascent or in patients with a history of repeated AMS. It improves symptomatic periodic breathing and hypoxia experienced at high altitudes. Acetazolamide is not indicated for general prophylaxis of AMS. Treatment of AMS may be discontinued when the patient is asymptomatic.

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Benzodiazepines

Class Summary

These agents are used to promote deeper stages of sleep.

Temazepam (Restoril)

The intermediate rate of absorption and duration of action make this drug useful for treating initial and middle insomnia. Temazepam has no active metabolites, which reduces cognitive impairment and grogginess the following day.

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Nonbenzodiazepine sedative hypnotic

Class Summary

These agents are used to consolidate sleep.

Zolpidem (Ambien)

Zolpidem is rapidly absorbed, with a fast onset of action (20-30 min), which makes this a good drug for sleep induction. The ER product (Ambien CR) consists of a coated 2-layer tablet and is useful for insomnia characterized by difficulties with sleep onset and/or sleep maintenance. The first layer releases drug content immediately to induce sleep, whereas second layer gradually releases additional drug to provide continuous sleep.

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Phosphodiesterase inhibitor

Class Summary

These agents are respiratory stimulants.

Theophylline (Theo-dur)

Theophylline has a number of physiological effects, including increases in collateral ventilation, respiratory muscle function, mucociliary clearance, and central respiratory drive. It partially acts by inhibiting phosphodiesterase, elevating cellular cyclic AMP levels, or antagonizing adenosine receptors in the bronchi, resulting in relaxation of smooth muscle. However, clinical efficacy is controversial, especially in acute settings.

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