Sleep apnoea is a cessation of breathing or reduction of respiratory activity during sleep. Pauses in breathing typically last for up to 40 seconds and must occur more than five times in one hour during each sleep cycle to be considered pathological. Risk factors associated with the condition include neuromuscular disorders, advanced age and excess weight.
A significant body of evidence associates sleep apnoea with an increased risk of being involved in a motor vehicle accident. This is because sleep apnoea is a major cause of restlessness and fatigue, which can lead to difficulties with concentration and recalling memories.
Obstructive sleep apnoea (OSA) is the cessation of breathing due to blockage of the airway. This can be caused by weakness of facial muscles, obesity, airway inflammation and swollen tonsils. It is possible, therefore, that sleep apnoea could be prevented by pharmacological means, such as controlling inflammation or treating neuromuscular disorders such as myasthenia gravis or Guillain-Barré syndrome. This is especially important because a number of neuromuscular disorders are progressive and affect more muscle groups as time goes by.
Pharmacologic prevention of OSA can be a potentially life-saving measure, both by reducing fatigue in susceptible individuals and by optimising breathing in people with musculoskeletal disorders. Non-pharmacotherapeutic prevention strategies include the use of a mandibular advancement splint and a surgical procedure known as a uvulopalatopharyngoplasty. Although these measures are highly effective in patients who are likely to develop mild OSA, recovery from surgery may require them to take time off work, school or other important commitments.
The widespread causes of OSA are often better able to be managed with pharmacotherapy compared to surgical procedures. Anti-inflammatory drugs such as prednisone and dexamethasone are genericised and widely available. These drugs could effectively manage autoimmune conditions that promote inflammation in the airway. Similarly, antioxidants such as edaravone can counter the effects of oxidative stress, which is a known driver of cardiovascular disease associated with OSA and other respiratory diseases. Edaravone is used to treat amyotrophic lateral sclerosis (ALS), which is often accompanied by hypoventilation and sleep apnoea. The anti-diabetic drug metformin may be used to assist obese individuals in weight loss endeavours, reducing the risk of developing endocrinopathies or metabolic syndrome.
Research into the pharmacological prevention of sleep apnoea is warranted because the prevalence of OSA continues to increase in line with growing numbers of people with neuromuscular conditions and excess weight. It is therefore imperative that proactive measures are taken to prevent people from developing OSA and, by association, reduce the frequency of OSA-related motor vehicle collisions around the world.