Sleep Apnea
Sleep apnea is a prevalent sleep-related breathing disorder characterized by recurrent episodes of partial or complete upper airway obstruction during sleep, resulting in intermittent hypoxia and sleep fragmentation. The pathogenesis involves anatomical and functional factors that compromise airway patency, including reduced pharyngeal muscle tone during sleep, craniofacial abnormalities, and increased adiposity in the neck region. These episodes of airway collapse lead to arousals from sleep, sympathetic nervous system activation, and chronic intermittent hypoxemia, which collectively contribute to a range of adverse health effects. Sleep apnea is associated with significant morbidity, including increased risk of hypertension, cardiovascular disease, metabolic dysfunction, neurocognitive impairment, and diminished quality of life. The condition is frequently underdiagnosed, and its chronic, progressive nature underscores the importance of early recognition and intervention.
Obstructive sleep apnea is the most common type of sleep apnea, characterized by repetitive episodes of partial or complete upper airway obstruction during sleep despite ongoing respiratory effort. The obstruction is usually due to the collapse of the pharyngeal airway, often exacerbated by anatomical factors such as enlarged tonsils, obesity, or craniofacial abnormalities. OSA leads to cyclical drops in blood oxygen saturation, frequent arousals from sleep, and excessive daytime sleepiness. It is associated with an increased risk of cardiovascular and metabolic disorders.
Central sleep apnea occurs when the brain fails to generate appropriate signals to the respiratory muscles, resulting in periods of absent or reduced respiratory effort during sleep. Unlike OSA, CSA is not primarily due to airway obstruction but rather a dysfunction in the central regulation of breathing. CSA is often seen in association with conditions such as heart failure, stroke, or the use of certain medications. Patients may experience disrupted sleep, nocturnal awakenings, and daytime fatigue.
Complex sleep apnea syndrome, also known as treatment-emergent central sleep apnea, is identified when central sleep apnea events emerge or persist during the treatment of obstructive sleep apnea, typically with continuous positive airway pressure (CPAP) therapy. This form represents a combination of obstructive and central mechanisms, and its management may require tailored therapeutic approaches.
Sleep apnea is a highly prevalent disorder, with obstructive sleep apnea affecting approximately 9% to 38% of the adult population globally, depending on diagnostic criteria and population studied. The prevalence increases with age, obesity, and male sex, with higher rates observed in individuals with comorbid conditions such as hypertension, heart failure, and type 2 diabetes. Men are two to three times more likely than women to develop sleep apnea, though the risk in women increases after menopause. Central sleep apnea is less common, accounting for a smaller proportion of cases, and is frequently associated with underlying cardiovascular or neurologic disease. The disorder is often under-recognized and underdiagnosed, contributing to significant public health burden due to its association with cardiovascular morbidity, accidents, and impaired quality of life.
The diagnosis of sleep apnea is established through a combination of clinical evaluation and objective sleep studies. Clinical assessment includes a thorough history focusing on symptoms such as loud snoring, witnessed apneas, nocturnal choking or gasping, excessive daytime sleepiness, and the presence of risk factors like obesity or craniofacial abnormalities. Physical examination may reveal findings such as increased neck circumference or upper airway crowding. The gold standard for diagnosis is overnight polysomnography, an attended sleep study that monitors respiratory events, oxygen saturation, electroencephalography, electromyography, and electrooculography during sleep. The apnea-hypopnea index (AHI), which quantifies the number of apneas and hypopneas per hour of sleep, is used to define disease severity: mild (AHI 5–14), moderate (AHI 15–29), and severe (AHI ≥30). Home sleep apnea testing, which utilizes portable monitoring devices, may be appropriate for selected patients with a high pretest probability of moderate to severe obstructive sleep apnea and without significant comorbidities. Additional evaluations may include assessment of daytime sleepiness using validated scales such as the Epworth Sleepiness Scale, and screening for associated comorbidities.
Tirzepatide is available as a treatment option and may be utilized in the management of sleep apnea. Solriamfetol hydrochloride is indicated for improving wakefulness in adults experiencing excessive daytime sleepiness associated with sleep apnea. Armodafinil, also known as (R)-modafinil, is prescribed to promote wakefulness in patients with sleep apnea who continue to experience significant daytime sleepiness despite primary therapy. Modafinil is another agent employed to address excessive sleepiness in individuals with sleep apnea, providing symptomatic relief and enhancing daytime function.
| Structure | Generic Name | CAS Registry Number | Molecular Formula | Molecular Weight |
|---|---|---|---|---|
 | tirzepatide (Rec INN; USAN) | 2023788-19-2 | C225 H348 N48 O68 | 4813.451 |
 | solriamfetol hydrochloride (Rec INNM; USAN) | 178429-62-4 (free base) | C10 H14 N2 O2 . Cl H | 230.691 |
 | (-)-modafinil; (R)-modafinil; armodafinil (Rec INN; USAN); l-modafinil | 112111-43-0 | C15 H15 N O2 S | 273.35 |
 | modafinil (Rec INN) | 68693-11-8 | C15 H15 N O2 S | 273.35 |
Make Order
Experimental Scheme
Implementation
Conclusion
