Latest treatment options for sleep apnea
What is the usual sequence of diagnostic and therapeutic steps for patients with sleep apnea?
Most such patients are overweight or obese, and many have bed partners who note snoring and/or witness apneic episodes during sleep. The Berlin questionnaire may be useful in screening, but a polysomnographic sleep study is typically required for diagnosis. Cohort studies have shown a significant improvement in survival if continuous positive airway pressure (CPAP) is used during sleep; a meta-analysis of 18 randomized, clinical trials suggests that CPAP significantly lowers 24-hour ambulatory blood pressures (by about 2/2 mm Hg) but not cardiovascular events (odds ratio [OR] = 0.84, 95% confidence interval [CI]: 0.62 to 1.13) or death (OR = 0.85, 95% CI: 0.35 to 2.06). In patients with hyperaldosteronism and sleep apnea, CPAP is recommended primarily for its improvement in quality of life; blood pressure can typically be reduced even further by adding spironolactone or eplerenone; a serum aldosterone/renin ratio is often measured before starting such treatment.
