# Obstructive Sleep Apnoea - Category: chronic - Review status: reviewed (every claim checked against a document named on this page) - Sources: Obstructive Sleep Apnea - StatPearls (NCBI Bookshelf NBK459252) - https://www.ncbi.nlm.nih.gov/books/NBK459252/: "Weight loss should be encouraged in patients with OSA.", "Patients should be advised to avoid alcohol, benzodiazepines, opiates, and certain antidepressants, as these substances can worsen their condition.", "OSA that is more pronounced in the supine position can be treated with a positioning device to maintain side-sleeping, which can be an effective option." and "Nighttime in-laboratory level 1 polysomnography (PSG) is considered the gold standard for diagnosing OSA." · Egyptian National Drug Formulary, respiratory 2026, fluticasone monograph, intranasal (printed p. 68) · No labelled dose - isotonic saline irrigation, used as often as it helps - Verified date: 2026-08 ## Verified against - Obstructive Sleep Apnea - StatPearls (NCBI Bookshelf NBK459252) - https://www.ncbi.nlm.nih.gov/books/NBK459252/: "Weight loss should be encouraged in patients with OSA.", "Patients should be advised to avoid alcohol, benzodiazepines, opiates, and certain antidepressants, as these substances can worsen their condition.", "OSA that is more pronounced in the supine position can be treated with a positioning device to maintain side-sleeping, which can be an effective option." and "Nighttime in-laboratory level 1 polysomnography (PSG) is considered the gold standard for diagnosing OSA." - No labelled dose - isotonic saline irrigation, used as often as it helps - Egyptian National Drug Formulary, respiratory 2026, fluticasone monograph, intranasal (printed p. 68) ## Treatment metadata - No drug therapy in primary care (Lifestyle & Referral) - Sodium chloride — spray - Fluticasone propionate — 0.05 mg — nasal ## Complete treatment card ```text OBSTRUCTIVE SLEEP APNOEA Sources: Obstructive Sleep Apnea - StatPearls (NCBI Bookshelf NBK459252) - https://www.ncbi.nlm.nih.gov/books/NBK459252/: "Weight loss should be encouraged in patients with OSA.", "Patients should be advised to avoid alcohol, benzodiazepines, opiates, and certain antidepressants, as these substances can worsen their condition.", "OSA that is more pronounced in the supine position can be treated with a positioning device to maintain side-sleeping, which can be an effective option." and "Nighttime in- laboratory level 1 polysomnography (PSG) is considered the gold standard for diagnosing OSA." · Egyptian National Drug Formulary, respiratory 2026, fluticasone monograph, intranasal (printed p. 68) · No labelled dose - isotonic saline irrigation, used as often as it helps Review status: REVIEWED against 3 sources listed above (2026-08) IS IT THIS? - reference only, to read alongside your own examination SYMPTOMS - what the patient reports (4) - Loud snoring, choking or gasping at night, and observed pauses in breathing accompany marked daytime sleepiness [apnoea · drowsiness · snoring] - Some patients report only daytime fatigue rather than true sleepiness [fatigue] - Morning headaches, nighttime reflux, insomnia, and nocturia can also occur [heartburn · insomnia · nocturia] - An Epworth score above 9, out of a 0-to-24 scale, flags excessive daytime sleepiness for further workup [drowsiness] SIGNS - what you find (5) - Obesity is the single most common finding in people with OSA [obesity] - A large neck - over 17 in (43 cm) in men or 16 in (40.5 cm) in women - is a physical sign - A crowded oropharynx with a Mallampati score of 3 to 4 or a large tongue supports the diagnosis - Lateral airway narrowing is the only sign that independently predicts OSA once weight and neck size are factored in [stricture] - A STOP-BANG score of 5 or more yes answers signals high risk for moderate-to-severe OSA TESTS (7) - In-laboratory level 1 polysomnography is the gold standard for diagnosing OSA - Hypopnea needs at least a 30% airflow drop lasting over 10 seconds with at least 4% desaturation - Scoring apnea needs at least a 90% flow drop lasting at least 10 seconds - Obstructive apnea shows ongoing respiratory effort throughout; central apnea shows none - Home sleep testing suits adults with high pretest probability and no major comorbidity like advanced heart failure or COPD - Home testing can underestimate the AHI by at least 20% since it lacks EEG-confirmed sleep time - Severity by AHI is graded mild 5 to 15, moderate over 15 to 30, and severe over 30 events per hour IF NOT THIS - what else fits (4) - Asthma and central sleep apnea are considered on the differential - COPD and depression can present with overlapping fatigue or breathing symptoms - Gastroesophageal reflux and hypothyroidism are on the differential - Narcolepsy and periodic limb movement disorder are also considered Source StatPearls "Obstructive Sleep Apnea" - disease-level clinical article Status traced to the source above Rx: Main treatment | Nasal irrigation | If allergic rhinitis coexists MAIN TREATMENT 1. NO DRUG THERAPY IN PRIMARY CARE (LIFESTYLE & REFERRAL) [1st line] Adult Counsel on weight loss, positional therapy (avoiding supine sleep), and avoidance of evening alcohol and sedatives. Refer for diagnostic polysomnography (sleep study) and Continuous Positive Airway Pressure (CPAP) evaluation. Source Obstructive Sleep Apnea - StatPearls (NCBI Bookshelf NBK459252) - https://www.ncbi.nlm.nih.gov/books/NBK459252/: "Weight loss should be encouraged in patients with OSA.", "Patients should be advised to avoid alcohol, benzodiazepines, opiates, and certain antidepressants, as these substances can worsen their condition.", "OSA that is more pronounced in the supine position can be treated with a positioning device to maintain side-sleeping, which can be an effective option." and "Nighttime in- laboratory level 1 polysomnography (PSG) is considered the gold standard for diagnosing OSA." Why OSA is managed primarily with non-pharmacological interventions (CPAP, weight loss, positional therapy); no primary oral or inhaled drug therapy exists in primary care. Caution In Egypt, polysomnography (sleep study) and CPAP titration are obtained via university hospital sleep centers (e.g., Kasr Al-Ainy, Ain Shams, Alexandria) or private pulmonology centers; CPAP devices are usually self-funded or arranged via Health Insurance Authority approval. Avoid prescribing central nervous system depressants, sedatives, hypnotics, or alcohol, which exacerbate upper airway collapsibility and nocturnal hypoxemia. NASAL IRRIGATION - give alongside 2. SODIUM CHLORIDE [add-on - not a substitute] Adult 2-3 sprays per nostril at bedtime PRN to clear nasal congestion and optimize nasal breathing - long-term PRN Peds 1-2 sprays per nostril bedtime PRN Source No labelled dose - isotonic saline irrigation, used as often as it helps Why Isotonic saline irrigation that clears nasal congestion to optimize nasal airflow, added alongside CPAP and weight loss, not a replacement for either as the definitive OSA therapy. Caution Continuous Positive Airway Pressure (CPAP) and weight loss are primary definitive therapies; pharmacotherapy is adjunctive. Refer for formal polysomnography (sleep study). Advise avoidance of evening alcohol and sedatives. Saline has no licensed dose - it is salt water. Use it as often as it clears the nose. Egypt RHINO-MARINE PEDIATRIC NASAL SPRAY 60 ML SEKEM 32.00 EGP FREE NOSE NASAL SPRAY 30 ML (0-6 YEARS) PHARMALINK S.L. > AUG PHARMA 75.00 EGP FREE NOSE NASAL SPRAY 30 ML (6+ YEARS) PHARMALINK S.L. > AUG PHARMA 75.00 EGP SOFIMER 0.9% MINI ISOTONIC NASAL SPRAY 30 ML > SOFICOPHARM 170.00 EGP PHYSIOMER NORMAL JET NASAL SPRAY 135ML LABORATOIRE DE LA MER > STAR INTE... 300.00 EGP EAU DE MER ISOTONIC NASAL SPRAY 30% 100ML > SANDOZ 350.00 EGP MARIMER ISOTONIC NASAL SPRAY 100ML LABORATOIRES GILBERT - FRANCE > UNITE... 385.00 EGP PHYSIOMER BABY MIST NASAL SPRAY 115ML LABORATOIRE DE LA MER > STAR INTER... 400.00 EGP IF ALLERGIC RHINITIS COEXISTS - give alongside 3. FLUTICASONE PROPIONATE [add-on - not a substitute] Adult 2 sprays (100 mcg) into each nostril once daily in the morning for co-existing allergic rhinitis component Peds 4 to 12 years: 1 spray (50 mcg fluticasone propionate) into each nostril once daily, preferably in the morning. Maximum 100 mcg a day. 12 years and over: Adult dosing. (Ages 4-12 years: Start with 1 spray (50 mcg fluticasone propionate) into each nostril once daily, preferably in the morning (max daily dose 100 mcg). Ages 12 and over receive adult dosing.) Source Egyptian National Drug Formulary, respiratory 2026, fluticasone monograph, intranasal (printed p. 68) Why Intranasal corticosteroid added for a coexisting allergic rhinitis component that worsens nasal obstruction, not a treatment for the apnea itself; CPAP and weight loss remain the definitive therapies. Caution Requires 1-2 weeks of continuous use for optimal efficacy. May cause localized epistaxis or nasal irritation. Egypt RHINORELIEF NASAL SUSP. 50 MCG/METERED SPRAY DOSE ARAB DRUG COMPANY (ADCO) 32.00 EGP FLIX NASAL SPRAY 50 MCG/METERED SPRAY DOSE EVA PHARMA 76.00 EGP FLIXONASE 50 MCG/METERED NASAL SPRAY 120 DOSE GLAXO SMITHKLINE 133.00 EGP FLIXOTIDE DISKUS 50MCG/DOSE ACCUHALER GLAXO SMITHKLINE 36.00 EGP FLIXOTIDE EVOHALER 50MCG/ACTUATION INHALER GLAXO SMITHKLINE 111.00 EGP Prices are indicative (dataset snapshot 2026-06); verify with the pharmacy. ``` --- Dawaa Reference is a reference for prescribers, not a medical device, and does not replace clinical judgement. [Privacy policy](/privacy)