Dawaa Reference

chronic

Obstructive Sleep Apnoea

Treatment options, dosing, cautions and Egyptian brands from the shipped Dawaa Reference card.

Evidence status

Checked against the sources named below

Sources3 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 against3 documents
  • 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)

Verified date2026-08

Presentation reference

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

SourceStatPearls "Obstructive Sleep Apnea" - disease-level clinical article

Presentation findings are 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 dose and duration

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.

Dose 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.

Cautions
  • 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

Nasal irrigation

add-on - not a substitute

Formspray

Adult dose and duration

2-3 sprays per nostril at bedtime PRN to clear nasal congestion and optimize nasal breathing - long-term PRN

Paediatric dose

1-2 sprays per nostril bedtime PRN

Dose 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.

Cautions
  • 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.
Egyptian brands
Egyptian brandManufacturerIndicative price
RHINO-MARINE PEDIATRIC NASAL SPRAY 60 MLSEKEM32.00 EGP
FREE NOSE NASAL SPRAY 30 ML (0-6 YEARS)PHARMALINK S.L. > AUG PHARMA75.00 EGP
FREE NOSE NASAL SPRAY 30 ML (6+ YEARS)PHARMALINK S.L. > AUG PHARMA75.00 EGP
SOFIMER 0.9% MINI ISOTONIC NASAL SPRAY 30 ML> SOFICOPHARM170.00 EGP
PHYSIOMER NORMAL JET NASAL SPRAY 135MLLABORATOIRE DE LA MER > STAR INTERNATIONAL COMPANY300.00 EGP
EAU DE MER ISOTONIC NASAL SPRAY 30% 100ML> SANDOZ350.00 EGP
MARIMER ISOTONIC NASAL SPRAY 100MLLABORATOIRES GILBERT - FRANCE > UNITED BIONAT385.00 EGP
PHYSIOMER BABY MIST NASAL SPRAY 115MLLABORATOIRE DE LA MER > STAR INTERNATIONAL COMPANY400.00 EGP

IF ALLERGIC RHINITIS COEXISTS - give alongside

3

FLUTICASONE PROPIONATE

If allergic rhinitis coexists

add-on - not a substitute

Strength0.05 mg

Formnasal

Adult dose and duration

2 sprays (100 mcg) into each nostril once daily in the morning for co-existing allergic rhinitis component

Paediatric dose

(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.)

Dose by age
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.
Dose 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.

Cautions
  • Requires 1-2 weeks of continuous use for optimal efficacy.
  • May cause localized epistaxis or nasal irritation.
Egyptian brands
Egyptian brandManufacturerIndicative price
RHINORELIEF NASAL SUSP. 50 MCG/METERED SPRAY DOSEARAB DRUG COMPANY (ADCO)32.00 EGP
FLIX NASAL SPRAY 50 MCG/METERED SPRAY DOSEEVA PHARMA76.00 EGP
FLIXONASE 50 MCG/METERED NASAL SPRAY 120 DOSEGLAXO SMITHKLINE133.00 EGP
FLIXOTIDE DISKUS 50MCG/DOSE ACCUHALERGLAXO SMITHKLINE36.00 EGP
FLIXOTIDE EVOHALER 50MCG/ACTUATION INHALERGLAXO SMITHKLINE111.00 EGP

Prices are indicative (dataset snapshot 2026-06); verify with the pharmacy.