Which Drugs Have Positive, Negative Impacts on Sleep Apnea?

A new review of obstructive sleep apnea (OSA) and potential underlying drug interactions, has identified drugs that exacerbate OSA and should be avoided.

The researchers analyzed the Medline database for studies that mentioned drugs and looked at an effect on OSA. They classified each study as A, B, or C, depending on the level of evidence. Studies classified as A were randomized control trials (RCTs) with high statistical power, B classifications were given to RCTs with low power, non-randomized comparative studies and observational studies, and C classifications were given to retrospective and case studies.

The researchers found that opioids and opiates worsened OSA. Seventy-five to 85% of patients treated with opioids have at least mild sleep apnea that is severe in 36 to 41% of cases depending on the dose. The researchers hypothesize that long-term opioid therapy seems to induce sleep-disordered breathing (SDB) “by increasing the number of central apneas and decreasing the number of obstructive apneas.” 

Other drugs that may negatively affect OSA were benzodiazepines, testosterone, baclofen and drugs that induce weight gain (atypical antipsychotics, antidepressants, anticonvulsants, diabetes agents, antihistamines, β- and α-adrenergic blockers).

As for positive impacts on OSA, the researchers found improvements were demonstrated with the use of anti-inflammatory drugs, antileukotrienes, nasal corticosteroids, topical soft tissue lubricants, diuretics and other antihypertensives, beat-2 agonists, acetylcholinestarase inhibitors, female hormones, anti-Parkinson’s medications and medical gases.

However, the evidence for the possible positive influence of these drugs was not as great as the evidence for drugs listed for negative impacts. Within some drug classifications contrasting outcomes were noted for different treatments. ‘Z’ drugs or non-benzodiazepines and sodium oxybate in particular should be used with caution as the literature contains conflicting results.

Larger trials are needed to confirm any potential positive impacts from these treatments, but in the meantime, the authors highlight how diuretics or other antihypertensive drugs may be helpful in reducing OSA-associated cardiovascular morbidity.

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