Evidence-based strategies for the treatment of sleep apnea: a systematic literature review

Obstructive sleep apnea is a common sleep disorder characterized by repeated upper airway obstruction during sleep, causing intermittent oxygen desaturation, sleep fragmentation, and reduced quality of life. Among the main treatments, continuous positive airway pressure and nocturnal oxygen therapy are widely used. Despite their efficacy, both have limitations, including poor long-term adherence, device-induced discomfort, and the need for regular monitoring. The pharmacist can play a key role in improving therapeutic support and adherence. This review aims to evaluate the effectiveness and safety of continuous positive airway pressure and nocturnal oxygen therapy in the treatment of obstructive sleep apnea and to identify pharmaceutical interventions to optimize adherence and manage adverse effects. This systematic review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and included studies from PubMed, Cochrane Library, and ScienceDirect involving adults treated with these therapies. Thirty-one studies were included. Across the included studies, continuous positive airway pressure therapy consistently reduced the apnea-hypopnea index by approximately 15 to 30 events per hour, often corresponding to a relative reduction exceeding 50% from baseline. Improvements in nocturnal oxygenation were also observed, with increases in mean SpO2 ranging from 2 to 9 percentage points. In cardiovascular outcomes, the use of continuous positive airway pressure was associated with reductions in nocturnal systolic blood pressure typically ranging from 3 to 7 mmHg among adherent patients. Oxygen therapy improved oxygenation but showed variable effects on respiratory events and adherence. In conclusion, continuous positive airway pressure remains the reference treatment, while pharmacist interventions may strengthen adherence and optimize management.