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Pharmacologic approaches for the management of symptoms and cardiovascular consequences of obstructive sleep apnea in adults

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Abstract

Introduction

Obstructive sleep apnea (OSA) is characterized by intermittent hypoxemia, arousals from sleep, and daytime sleepiness. Accumulating evidence indicates that hypoxemia and sleep disruption contribute to the development of cardiovascular abnormalities in OSA. OSA is effectively treated with continuous positive airway pressure (CPAP) therapy that splints open the airway during sleep. Studies have shown that CPAP therapy improves daytime sleepiness and attenuates cardiovascular abnormalities in patients with OSA. However, not all patients with OSA tolerate or adhere to CPAP therapy. Even patients who regularly use CPAP therapy may have a few hours each night exposed to the negative effects of untreated OSA. As a result, complementary pharmacologic therapies that can be used with CPAP therapy have the potential to reduce symptoms and consequences of OSA.

Discussion

The wake-promoting medications modafinil and armodafinil effectively improve residual sleepiness in patients treated with CPAP therapy. Although results are equivocal so far, modafinil and armodafinil may also improve quality of life and global clinical condition in patients with OSA and residual sleepiness treated with CPAP therapy. Pharmacologic therapies also have the potential to be used with CPAP therapy to minimize cardiovascular perturbations and risk of cardiovascular disease. Preliminary studies suggest that inhibition of the enzyme xanthine oxidase and inhibition of sympathetic nervous system overactivity may have therapeutic potential to reduce cardiovascular harm in patients with OSA.

Conclusion

Future studies of pharmacologic therapies to reduce symptoms and cardiovascular consequences of OSA should be increasingly performed as our understanding of the mechanisms mediating the adverse effects of OSA continues to evolve.

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References

  1. Peppard PE, Young T, Palta M, Skatrud J (2000) Prospective study of the association between sleep-disordered breathing and hypertension. N Engl J Med 342:1378–1384

    Article  CAS  PubMed  Google Scholar 

  2. Sharafkhaneh N, Giray P, Richardson P, Young T, Hirshkowitz M (2005) Association of psychiatric disorders and sleep apnea in a large cohort. Sleep 28:1405–1411

    PubMed  Google Scholar 

  3. Carlson JT, Hedner J, Elam M, Ejnell H, Sellgren J, Wallin BG (1993) Augmented resting sympathetic activity in awake patients with obstructive sleep apnea. Chest 103:1763–1768

    Article  CAS  PubMed  Google Scholar 

  4. Kato M, Roberts-Thomson P, Phillips BG, Haynes WG, Winnicki M, Accurso V, Somers VK (2000) Impairment of endothelium-dependent vasodilation of resistance vessels in patients with obstructive sleep apnea. Circulation 102:2607–2610

    CAS  PubMed  Google Scholar 

  5. Ryan S, McNicholas WT (2009) Inflammatory cardiovascular risk markers in obstructive sleep apnoea syndrome. Cardiovasc Hematol Agents Med Chem 7:76–81

    Article  CAS  PubMed  Google Scholar 

  6. Morgan BJ, Crabtree DC, Puleo DS, Badr MS, Toiber F, Skatrud JB (1996) Neurocirculatory consequences of abrupt change in sleep state in humans. J Appl Physiol 80:1627–1636

    CAS  PubMed  Google Scholar 

  7. Narkiewicz K, Kato M, Phillips BG, Pesek CA, Davison DE, Somers VK (1999) Nocturnal continuous positive airway pressure decreases daytime sympathetic traffic in obstructive sleep apnea. Circulation 100:2332–2335

    CAS  PubMed  Google Scholar 

  8. Imadojemu VA, Mawji Z, Kunselman A, Gray KS, Hogeman CS, Leuenberger UA (2007) Sympathetic chemoreflex responses in obstructive sleep apnea and effects of continuous positive airway pressure therapy. Chest 131:1406–1413

    Article  PubMed  Google Scholar 

  9. Dorkova Z, Perasova D, Molcanyiova A, Popovnakova M, Tkacova R (2008) Effects of continuous positive airway pressure on cardiovascular risk profile in patients with severe obstructive sleep apnea and metabolic syndrome. Chest 134:686–692

    Article  CAS  PubMed  Google Scholar 

  10. Kohler M, Bloch KE, Stradling JR (2009) Pharmacological approaches to the treatment of obstructive sleep apnoea. Expert Opin Investig Drugs 18:647–656

    Article  CAS  PubMed  Google Scholar 

  11. Tauman R, Gozal D (2006) Obesity and obstructive sleep apnea in children. Pediatr Respir Rev 7:247–259

    Article  Google Scholar 

  12. Engleman HM, Wild MR (2003) Improving CPAP use by patients with the sleep apnea/hypopnea syndrome. Sleep Med Rev 7:81–99

    Article  PubMed  Google Scholar 

  13. Kribbs NB, Pack AI, Kline LR, Getsy JE, Schuett JS, Henry JN, Maislin G, Dinges DF (1993) Effects of one night without CPAP treatment on sleep and sleepiness in patients with obstructive sleep apnea. Am Rev Respir Dis 47:1162–1168

    Google Scholar 

  14. Weaver TE, Kribbs NB, Pack AI, Kline LR, Chugh DK, Maislin G, Smith PL, Schwartz AR, Schubert NM, Gillen KA, Dinges DF (1997) Night-to-night variability in CPAP use over the first three months of treatment. Sleep 20:278–283

    CAS  PubMed  Google Scholar 

  15. Fitzpatrick MF, Alloway CE, Wakeford TM, MacLean AW, Munt PW, Day AG (2003) Can patients with obstructive sleep apnea titrate their own continuous positive airway pressure? Am J Respir Crit Care Med 167:716–722

    Article  PubMed  Google Scholar 

  16. Grote L, Hedner J, Grunstein R, Kraiczi H (2000) Therapy with CPAP: incomplete elimination of sleep related breathing disorder. Eur Respir J 16:921–927

    Article  CAS  PubMed  Google Scholar 

  17. Campos-Rodriguez F, Peña-Griñan N, Reyes-Nuñez N, De la Cruz-Moron I, Perez-Ronchel J, De la Vega-Gallardo F, Fernandez-Palacin A (2005) Mortality in obstructive sleep apnea–hypopnea syndrome patients treated with positive airway pressure. Chest 128:624–633

    Article  PubMed  Google Scholar 

  18. Weaver TE, Maislin G, Dinges DF, Bloxham T, George CF, Greenberg H, Kader G, Mahowald M, Younger J, Pack AI (2007) Relationship between hours of CPAP use and achieving normal levels of sleepiness and daily functioning. Sleep 30:711–719

    PubMed  Google Scholar 

  19. Santamaria J, Iranzo A, Ma Montserrat J, de Pablo J (2007) Persistent sleepiness in CPAP treated obstructive sleep apnea patients: evaluation and treatment. Sleep Med Rev 11:195–207

    Article  PubMed  Google Scholar 

  20. Bédard MA, Montplaisir J, Malo J, Richer F, Rouleau I (1993) Persistent neuropsychological deficits and vigilance impairment in sleep apnea syndrome after treatment with continuous positive airways pressure (CPAP). J Clin Exp Neuropsychol 15:330–341

    Article  PubMed  Google Scholar 

  21. Sforza E, Krieger J (1992) Daytime sleepiness after long-term continuous positive airway pressure (CPAP) treatment in obstructive sleep apnea syndrome. J Neurol Sci 110:21–26

    Article  CAS  PubMed  Google Scholar 

  22. Ferini-Strambi L, Baietto C, Di Gioia MR, Castaldi P, Castronovo C, Zucconi M, Cappa SF (2003) Cognitive dysfunction in patients with obstructive sleep apnea (OSA): partial reversibility after continuous positive airway pressure (CPAP). Brain Res Bull 61:87–92

    Article  CAS  PubMed  Google Scholar 

  23. Morison F, Décary A, Petit D, Lavigne G, Malo J, Montplaisir J (2001) Daytime sleepiness and EEG spectral analysis in apneic patients before and after treatment with continuous positive air pressure. Chest 119:45–52

    Article  Google Scholar 

  24. Morgenthaler TI, Kapen S, Lee-Chiong T, Alessi C, Boehlecke B, Brown T, Coleman J, Friedman L, Kapur V, Owens J, Pancer J, Swick T, Standards of Practice Committee; American Academy of Sleep Medicine (2006) Practice parameters for the medical therapy of obstructive sleep apnea. Sleep 29:1031–1035

    PubMed  Google Scholar 

  25. Kingshott RN, Vennelle M, Coleman EL, Engleman HM, Mackay TW, Douglas NJ (2001) Randomized, double-blind, placebo-controlled crossover trial of modafinil in the treatment of residual daytime excessive sleepiness in the sleep apnea/hypopnea syndrome. Am J Respir Crit Care Med 163:918–923

    CAS  PubMed  Google Scholar 

  26. Pack AI, Black JE, Schwartz JR, Matheson JK (2001) Modafinil as adjunct therapy for daytime sleepiness in the obstructive sleep apnea. Am J Respir Crit Care Med 164:1675–1681

    CAS  PubMed  Google Scholar 

  27. Black JE, Hirshkowitz M (2005) Modafinil for treatment of residual excessive sleepiness in nasal continuous positive airway pressure-treated obstructive sleep apnea/hypopnea syndrome. Sleep 28:464–471

    PubMed  Google Scholar 

  28. Dinges D, Weaver TE (2003) Effects of modafinil on sustained attention performance and quality of life in OSA patients with residual sleepiness while being treated with nCPAP. Sleep Medicine 4:393–402

    Article  PubMed  Google Scholar 

  29. Bittencourt LR, Lucchesi LM, Rueda AD, Garbuio SA, Palombini LO, Guilleminault C, Tufik S (2008) Placebo and modafinil effect on sleepiness in obstructive sleep apnea. Prog Neuropsychopharmacol Biol Psychiatry 32:552–559

    Article  CAS  PubMed  Google Scholar 

  30. Roth T, White D, Schmidt-Nowara W, Wesnes KA, Niebler G, Arora S, Black J (2006) Effects of armodafinil in the treatment of residual excessive sleepiness associated with obstructive sleep apnea/hypopnea syndrome: a 12-week, multicenter, double-blind, randomized, placebo-controlled study in nCPAP-adherent adults. Clin Ther 28:689–706

    Article  CAS  PubMed  Google Scholar 

  31. Roth T, Rippon GA, Arora S (2008) Armodafinil improves wakefulness and long-term episodic memory in nCPAP-adherent patients with excessive sleepiness associated with obstructive sleep apnea. Sleep Breath 12:53–62

    Article  PubMed  Google Scholar 

  32. Hirshkowitz M, Black JE, Wesnes K, Niebler G, Arora S, Roth T (2007) Adjunct armodafinil improves wakefulness and memory in obstructive sleep apnea/hypopnea syndrome. Respir Med 101:616–627

    Article  CAS  PubMed  Google Scholar 

  33. Bardwell WA, Ziegler MG, Ancoli-Israel S, Berry CC, Nelesen RA, Durning A, Dimsdale JE (2000) Does caffeine confound the relationships among adrenergic tone, blood pressure and sleep apnoea? J Sleep Res 9:269–272

    Article  CAS  PubMed  Google Scholar 

  34. Norman D, Bardwell WA, Loredo JS, Ancoli-Israel S, Heaton RK, Dimsdale JE (2008) Caffeine intake is independently associated with neuropsychological performances in patients with obstructive sleep apnea. Sleep Breath 12:199–205

    Article  PubMed  Google Scholar 

  35. Stradling JR, Smith D, Crosby J (2007) Post-CPAP sleepiness—a specific syndrome? J Sleep Res 16:436–438

    Article  PubMed  Google Scholar 

  36. Vgontzas AN AN, Zoumakis E, Lin HM, Bixler EO, Trakada G, Chrousos GP (2004) Marked decrease in sleepiness in patients with sleep apnea by etanercept, a tumor necrosis factor-alpha antagonist. J Clin Endocrinol Metab 89:4409–4413

    Article  PubMed  Google Scholar 

  37. Berry RB, Patel PB (2006) Effect of zolpidem on the efficacy of continuous positive airway pressure as treatment for obstructive sleep apnea. Sleep 29:1052–1056

    PubMed  Google Scholar 

  38. Rosenberg R, Roach JM, Scharf M, Amato DA (2007) A pilot study evaluating acute use of eszopiclone in patients with mild to moderate obstructive sleep apnea syndrome. Sleep Med 8:464–470

    Article  PubMed  Google Scholar 

  39. Bradshaw DA, Ruff GA, Murphy DP (2006) An oral hypnotic medication does not improve continuous positive airway pressure compliance in men with obstructive sleep apnea. Chest 130:1369–1376

    Article  PubMed  Google Scholar 

  40. Lettieri CJ, Shah AA, Holley AB, Kelly WF, Chang AS, Roop SA, Promotion CPAP, Prognosis – The Army Sleep Apnea Program Trial (2009) Effects of a short course of eszopiclone on continuous positive airway pressure adherence. Ann Intern Med 151:696–702

    PubMed  Google Scholar 

  41. Jelic S, Padeletti M, Kawut SM, Higgins C, Canfield SM, Onat D, Colombo PC, Basner RC, Factor P, LeJemtel TH (2008) Inflammation, oxidative stress, and repair capacity of the vascular endothelium in obstructive sleep apnea. Circulation 117:2270–2278

    Article  CAS  PubMed  Google Scholar 

  42. Sudano I, Spieker LE, Hermann F, Flammer A, Corti R, Noll G, Lüscher TF (2006) Protection of endothelial function: targets for nutritional and pharmacological interventions. J Cardiovasc Pharmacol 47(Suppl 2):S136–S150

    Article  CAS  PubMed  Google Scholar 

  43. Pialoux V, Hanly PJ, Foster GE, Brugniaux JV, Beaudin AE, Hartmann SE, Pun M, Duggan CT, Poulin MJ (2009) Effects of exposure to intermittent hypoxia on oxidative stress and acute hypoxic ventilatory response in humans. Am J Respir Crit Care Med 180:1002–1009

    Article  CAS  PubMed  Google Scholar 

  44. Schulz R, Mahmoudi S, Hattar K, Sibelius U, Olschewski H, Mayer K, Seeger W, Grimminger F (2000) Enhanced release of superoxide from polymorphonuclear neutrophils in obstructive sleep apnea. Impact of continuous positive airway pressure therapy. Am J Respir Crit Care Med 162:566–570

    CAS  PubMed  Google Scholar 

  45. Carpagnano GE, Kharitonov SA, Resta O, Foschino-Barbaro MP, Gramiccioni E, Barnes PJ (2002) Increased 8-isoprostane and interleukin-6 in breath condensate of obstructive sleep apnea patients. Chest 122:1162–1167

    Article  CAS  PubMed  Google Scholar 

  46. Lavie L, Vishnevsky A, Lavie P (2004) Evidence for lipid peroxidation in obstructive sleep apnea. Sleep 27:123–128

    PubMed  Google Scholar 

  47. Barceló A, Miralles C, Barbé F, Vila M, Pons S, Agustí AG (2000) Abnormal lipid peroxidation in patients with sleep apnoea. Eur Respir J 16:644–647

    Article  PubMed  Google Scholar 

  48. Christou K, Kostikas K, Pastaka C, Tanou K, Antoniadou I, Gourgoulianis KI (2009) Nasal continuous positive airway pressure treatment reduces systemic oxidative stress in patients with severe obstructive sleep apnea syndrome. Sleep Med 10:87–94

    Article  PubMed  Google Scholar 

  49. Dyugovskaya L, Lavie P, Lavie L (2002) Increased adhesion molecules expression and production of reactive oxygen species in leukocytes of sleep apnea patients. Am J Respir Crit Care Med 165:934–939

    PubMed  Google Scholar 

  50. Carpagnano GE, Kharitonov SA, Resta O, Foschino-Barbaro MP, Gramiccioni E, Barnes PJ (2003) 8-Isoprostane, a marker of oxidative stress, is increased in exhaled breath condensate of patients with obstructive sleep apnea after night and is reduced by continuous positive airway pressure therapy. Chest 124:1386–1392

    Article  CAS  PubMed  Google Scholar 

  51. De Lima AM, Franco CM, de Castro CM, Bezerra AD, Ataide L Jr, Halpern A (2009) Effects of nasal continuous positive airway pressure treatment on oxidative stress and adiponectin levels in obese patients with obstructive sleep apnea. Respiration 79:370–376. doi:10.1159/000227800

    Article  PubMed  Google Scholar 

  52. Lavie L, Lavie P (2009) Molecular mechanisms of cardiovascular disease in OSAHS: the oxidative stress link. Eur Respir J 33:1467–1484

    Article  CAS  PubMed  Google Scholar 

  53. Grebe M, Eisele HJ, Weissmann N, Schaefer C, Tillmanns H, Seeger W, Schulz R (2006) Antioxidant vitamin C improves endothelial function in obstructive sleep apnea. Am J Respir Crit Care Med 173:897–901

    Article  CAS  PubMed  Google Scholar 

  54. Yeboah J, Folsom AR, Burke GL, Johnson C, Polak JF, Post W, Lima JA, Crouse JR, Herrington DM (2009) Predictive value of brachial flow-mediated dilation for incident cardiovascular events in a population-based study. The Multi-Ethnic Study of Atherosclerosis. Circulation 120:502–509

    Article  PubMed  Google Scholar 

  55. Sherman DL, Keaney JF Jr, Biegelsen ES, Duffy SJ, Coffman JD, Vita JA (2000) Pharmacological concentrations of ascorbic acid are required for the beneficial effect on endothelial vasomotor tone in hypertension. Hypertension 35:936–941

    CAS  PubMed  Google Scholar 

  56. McCord JM (1985) Oxygen-derived free radicals in post-ischaemic tissue injury. N Engl J Med 312:159–163

    Article  CAS  PubMed  Google Scholar 

  57. Hassoun PM, Yu FS, Cote CG, Zulueta JJ, Sawhney R, Skinner KA, Skinner HB, Parks DA, Lanzillo JJ (1998) Upregulation of xanthine oxidase by lipopolysaccharide, interleukin-1 and hypoxia. Role in acute lung injury. Am J Respir Crit Care Med 158:299–305

    CAS  PubMed  Google Scholar 

  58. Kayyali US, Donaldson C, Huang H, Abdelnour R, Hassoun PM (2001) Phosphorylation of xanthine dehydrogenase/oxidase in hypoxia. J Biol Chem 276:14359–14365

    Article  CAS  PubMed  Google Scholar 

  59. El Solh AA, Saliba R, Bosinski T, Grant BJ, Berbary E, Miller N (2006) Allopurinol improves endothelial function in sleep apnoea: a randomised controlled study. Eur Respir J 27:997–1002

    PubMed  Google Scholar 

  60. Williams AL, Chen L, Scharf SM (2009) Effects of allopurinol on cardiac function and oxidant stress in chronic intermittent hypoxia. Sleep Breath. doi:10.1007/s11325-009-0279-x

    PubMed  Google Scholar 

  61. Moller DS, Lind P, Strunge B, Pedersen EB (2003) Abnormal vasoactive hormones and 24-hour blood pressure in obstructive sleep apnea. Am J Hypertens 16:274–280

    Article  CAS  PubMed  Google Scholar 

  62. Dimsdale JE, Coy T, Ziegler MG, Ancoli-Israel S, Clausen J (1995) The effect of sleep apnea on plasma and urinary catecholamines. Sleep 18:377–381

    CAS  PubMed  Google Scholar 

  63. Kizawa T, Nakamura Y, Takahashi S, Sakurai S, Yamauchi K, Inove H (2009) Pathogenic role of angiotensin II and oxidized LDL in obstructive sleep apnoea. Eur Respir J 34:1390–1398

    Article  CAS  PubMed  Google Scholar 

  64. Gjørup PH, Sadauskiene L, Wessels J, Nyvad O, Strunge B, Pederesen EB (2007) Abnormally increased endothelin-1 in plasma during the night in obstructive sleep apnea: relation to blood pressure and severity of disease. Am J Hypertens 20:44–52

    Article  PubMed  Google Scholar 

  65. Takahashi S, Nakamura Y, Nishijima T, Sakurai S, Inoue H (2005) Essential roles of angiotensin II in vascular endothelial growth factor expression in sleep apnea syndrome. Respir Med 99:1125–1131

    Article  PubMed  Google Scholar 

  66. Maillard D, Fineyre F, Dreyfuss D, Djedaini K, Blanchet F, Paycha F, Dussaule JC, Nittenberg A (1997) Pressure-heart rate responses to α-adrenergic stimulation and hormonal regulation in normotensive patients with obstructive sleep apnea. Am J Hypertens 10:24–31

    Article  CAS  PubMed  Google Scholar 

  67. Calhoun DA, Nishizaka MK, Zaman MA, Harding SM (2004) Aldosterone excretion among subjects with resistant hypertension and symptoms of sleep apnea. Chest 125:112–117

    Article  CAS  PubMed  Google Scholar 

  68. Fletcher EC, Bao G, Li R (1999) Renin activity and blood pressure in response to chronic episodic hypoxia. Hypertension 34:309–314

    CAS  PubMed  Google Scholar 

  69. Marcus NJ, Li YL, Bird CE, Schultz HD, Morgan BJ (2010) Chronic intermittent hypoxia augments chemoreflex control of sympathetic activity: role of the angiotensin II type 1 receptor. Respir Physiol Neurobiol 171:36–45

    Article  CAS  PubMed  Google Scholar 

  70. Weiss JW, Liu MD, Huang J (2007) Sleep apnoea and hypertension: physiological bases for a causal relation: physiological basis for a causal relationship of obstructive sleep apnoea to hypertension. Exp Physiol 92:21–26

    Article  CAS  PubMed  Google Scholar 

  71. Zimmerman MC, Lazartigues E, Lang JA, Sinnayah P, Ahmad IM, Spitz DR, Davisson RL (2002) Superoxide mediates the actions of angiotensin II in the central nervous system. Circ Res 91:1038–1045

    Article  CAS  PubMed  Google Scholar 

  72. Zucker IH (2002) Brain angiotensin II: new insights into its role in sympathetic regulation. Circ Res 90:503–505

    Article  CAS  PubMed  Google Scholar 

  73. Kraiczi H, Hedner J, Peker Y, Grote L (1999) Comparison of atenolol, amlodipine, enalapril, hydrochlorothiazide, and losartan for antihypertensive treatment in patients with obstructive sleep apnea. Am J Respir Crit Care Med 161:1423–1428

    Google Scholar 

  74. Helgeland A, Strommen R, Hagelund CH, Tretli S (1986) Enalapril, atenolol, and hydrochlorothiazide in mild to moderate hypertension: a comparative multicentre study in general practice in Norway. Lancet 1:872–875

    Article  CAS  PubMed  Google Scholar 

  75. Wilson T, Lacourclere WY, Barnes CC (1998) The antihypertensive efficacy of losartan and amlodipine assessed with office and ambulatory blood pressure monitoring. Canadian Cozaar Hyzaar Amlodipine Trial Study Group. CMAJ 159:469–476

    CAS  PubMed  Google Scholar 

  76. Dahlof B, Keller SE, Makris L, Goldberg AI, Sweet CS, Lim NY (1995) Efficacy and tolerability of losartan potassium and atenolol in patients with mild to moderate essential hypertension. Am J Hypertens 8:578–583

    Article  CAS  PubMed  Google Scholar 

  77. Edmonds D, Greminger P, Locher R, Knorr M, Vetter H, Vetter W (1986) Enalapril as a first-step agent in essential hypertension: a comparative study with atenolol. J Hypertens 4(Suppl):S406–S409

    CAS  Google Scholar 

  78. Frishman WH, Brobyn R, Brown RD, Johnson BF, Reeves RL, Wombolt DG (1994) Amlodipine versus atenolol in essential hypertension. Am J Cardiol 73:50A–54A

    Article  CAS  PubMed  Google Scholar 

  79. Gaddam K, Pimenta E, Thomas SJ, Cofield SS, Oparil S, Harding SM, Calhoun DA (2010) Spironolactone reduces severity of obstructive sleep apnoea in patients with resistant hypertension: a preliminary report. J Hum Hypertens doi:10.1038/jhh.2009.96

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Authors and Affiliations

  1. Pharmacy Practice Division, School of Pharmacy, University of Wisconsin, Madison, WI, USA

    John M. Dopp

  2. Department of Orthopedics and Rehabilitation, School of Medicine and Public Health, University of Wisconsin, Madison, WI, USA

    Barbara J. Morgan

  3. School of Pharmacy, University of Wisconsin–Madison, Madison, WI, 53705, USA

    John M. Dopp

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Dopp, J.M., Morgan, B.J. Pharmacologic approaches for the management of symptoms and cardiovascular consequences of obstructive sleep apnea in adults. Sleep Breath 14, 307–315 (2010). https://doi.org/10.1007/s11325-010-0383-y

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