{
  "schema_version": 1,
  "kind": "condition",
  "id": "obstructive-sleep-apnoea",
  "name": "Obstructive Sleep Apnoea",
  "category": "chronic",
  "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",
  "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)",
  "verified_date": "2026-08",
  "treatments": [
    {
      "id": 1234,
      "generic": "No drug therapy in primary care (Lifestyle & Referral)",
      "line": 1,
      "is_adjunct": false,
      "form": null,
      "strength_mg": null,
      "adult_dose": "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.",
      "adult_duration": null,
      "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.\"",
      "rationale": "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."
      ],
      "peds_mgkg_low": null,
      "peds_mgkg_high": null,
      "peds_max_mg": null,
      "peds_basis": null,
      "peds_unit": null,
      "peds_note": null,
      "peds_min_weight_kg": null,
      "peds_max_weight_kg": null,
      "peds_age_min_months": null,
      "peds_age_max_months": null,
      "peds_age_bands": null,
      "peds_doses": null,
      "brands": [],
      "condition_id": "obstructive-sleep-apnoea"
    },
    {
      "id": 1235,
      "generic": "Sodium chloride",
      "line": 1,
      "is_adjunct": true,
      "form": "spray",
      "strength_mg": null,
      "adult_dose": "2-3 sprays per nostril at bedtime PRN to clear nasal congestion and optimize nasal breathing",
      "adult_duration": "long-term PRN",
      "dose_source": "No labelled dose - isotonic saline irrigation, used as often as it helps",
      "rationale": "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."
      ],
      "peds_mgkg_low": null,
      "peds_mgkg_high": null,
      "peds_max_mg": null,
      "peds_basis": null,
      "peds_unit": null,
      "peds_note": "1-2 sprays per nostril bedtime PRN",
      "peds_min_weight_kg": null,
      "peds_max_weight_kg": null,
      "peds_age_min_months": null,
      "peds_age_max_months": null,
      "peds_age_bands": null,
      "peds_doses": null,
      "brands": [
        {
          "trade_name": "RHINO-MARINE PEDIATRIC NASAL SPRAY 60 ML",
          "scientific_name": null,
          "normalized_ingredient": null,
          "manufacturer": "SEKEM",
          "price_egp": 32.0,
          "pack_count": null,
          "unit_price": null,
          "strength_mg": null,
          "exact_strength": true,
          "exact_form": true,
          "discontinued": false,
          "also_contains": null
        },
        {
          "trade_name": "FREE NOSE NASAL SPRAY 30 ML (0-6 YEARS)",
          "scientific_name": null,
          "normalized_ingredient": null,
          "manufacturer": "PHARMALINK S.L. > AUG PHARMA",
          "price_egp": 75.0,
          "pack_count": null,
          "unit_price": null,
          "strength_mg": null,
          "exact_strength": true,
          "exact_form": true,
          "discontinued": false,
          "also_contains": null
        },
        {
          "trade_name": "FREE NOSE NASAL SPRAY 30 ML (6+ YEARS)",
          "scientific_name": null,
          "normalized_ingredient": null,
          "manufacturer": "PHARMALINK S.L. > AUG PHARMA",
          "price_egp": 75.0,
          "pack_count": null,
          "unit_price": null,
          "strength_mg": null,
          "exact_strength": true,
          "exact_form": true,
          "discontinued": false,
          "also_contains": null
        },
        {
          "trade_name": "SOFIMER 0.9% MINI ISOTONIC NASAL SPRAY 30 ML",
          "scientific_name": null,
          "normalized_ingredient": null,
          "manufacturer": "> SOFICOPHARM",
          "price_egp": 170.0,
          "pack_count": null,
          "unit_price": null,
          "strength_mg": null,
          "exact_strength": true,
          "exact_form": true,
          "discontinued": false,
          "also_contains": null
        },
        {
          "trade_name": "PHYSIOMER NORMAL JET NASAL SPRAY 135ML",
          "scientific_name": null,
          "normalized_ingredient": null,
          "manufacturer": "LABORATOIRE DE LA MER > STAR INTERNATIONAL COMPANY",
          "price_egp": 300.0,
          "pack_count": null,
          "unit_price": null,
          "strength_mg": null,
          "exact_strength": true,
          "exact_form": true,
          "discontinued": false,
          "also_contains": null
        },
        {
          "trade_name": "EAU DE MER ISOTONIC NASAL SPRAY 30% 100ML",
          "scientific_name": null,
          "normalized_ingredient": null,
          "manufacturer": "> SANDOZ",
          "price_egp": 350.0,
          "pack_count": null,
          "unit_price": null,
          "strength_mg": null,
          "exact_strength": true,
          "exact_form": true,
          "discontinued": false,
          "also_contains": null
        },
        {
          "trade_name": "MARIMER ISOTONIC NASAL SPRAY 100ML",
          "scientific_name": null,
          "normalized_ingredient": null,
          "manufacturer": "LABORATOIRES GILBERT - FRANCE > UNITED BIONAT",
          "price_egp": 385.0,
          "pack_count": null,
          "unit_price": null,
          "strength_mg": null,
          "exact_strength": true,
          "exact_form": true,
          "discontinued": false,
          "also_contains": null
        },
        {
          "trade_name": "PHYSIOMER BABY MIST NASAL SPRAY 115ML",
          "scientific_name": null,
          "normalized_ingredient": null,
          "manufacturer": "LABORATOIRE DE LA MER > STAR INTERNATIONAL COMPANY",
          "price_egp": 400.0,
          "pack_count": null,
          "unit_price": null,
          "strength_mg": null,
          "exact_strength": true,
          "exact_form": true,
          "discontinued": false,
          "also_contains": null
        }
      ],
      "condition_id": "obstructive-sleep-apnoea"
    },
    {
      "id": 1236,
      "generic": "Fluticasone propionate",
      "line": 1,
      "is_adjunct": true,
      "form": "nasal",
      "strength_mg": 0.05,
      "adult_dose": "2 sprays (100 mcg) into each nostril once daily in the morning for co-existing allergic rhinitis component",
      "adult_duration": null,
      "dose_source": "Egyptian National Drug Formulary, respiratory 2026, fluticasone monograph, intranasal (printed p. 68)",
      "rationale": "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."
      ],
      "peds_mgkg_low": null,
      "peds_mgkg_high": null,
      "peds_max_mg": null,
      "peds_basis": null,
      "peds_unit": null,
      "peds_note": "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.",
      "peds_min_weight_kg": null,
      "peds_max_weight_kg": null,
      "peds_age_min_months": null,
      "peds_age_max_months": null,
      "peds_age_bands": [
        {
          "label": "4 to 12 years",
          "age_min_months": 48,
          "age_max_months": 143,
          "dose_text": "1 spray (50 mcg fluticasone propionate) into each nostril once daily, preferably in the morning. Maximum 100 mcg a day."
        },
        {
          "label": "12 years and over",
          "age_min_months": 144,
          "age_max_months": 216,
          "dose_text": "Adult dosing."
        }
      ],
      "peds_doses": null,
      "brands": [
        {
          "trade_name": "RHINORELIEF NASAL SUSP. 50 MCG/METERED SPRAY DOSE",
          "scientific_name": null,
          "normalized_ingredient": null,
          "manufacturer": "ARAB DRUG COMPANY (ADCO)",
          "price_egp": 32.0,
          "pack_count": null,
          "unit_price": null,
          "strength_mg": 0.05,
          "exact_strength": true,
          "exact_form": true,
          "discontinued": false,
          "also_contains": null
        },
        {
          "trade_name": "FLIX NASAL SPRAY 50 MCG/METERED SPRAY DOSE",
          "scientific_name": null,
          "normalized_ingredient": null,
          "manufacturer": "EVA PHARMA",
          "price_egp": 76.0,
          "pack_count": null,
          "unit_price": null,
          "strength_mg": 0.05,
          "exact_strength": true,
          "exact_form": true,
          "discontinued": false,
          "also_contains": null
        },
        {
          "trade_name": "FLIXONASE 50 MCG/METERED NASAL SPRAY 120 DOSE",
          "scientific_name": null,
          "normalized_ingredient": null,
          "manufacturer": "GLAXO SMITHKLINE",
          "price_egp": 133.0,
          "pack_count": null,
          "unit_price": null,
          "strength_mg": 0.05,
          "exact_strength": true,
          "exact_form": true,
          "discontinued": false,
          "also_contains": null
        },
        {
          "trade_name": "FLIXOTIDE DISKUS 50MCG/DOSE ACCUHALER",
          "scientific_name": null,
          "normalized_ingredient": null,
          "manufacturer": "GLAXO SMITHKLINE",
          "price_egp": 36.0,
          "pack_count": null,
          "unit_price": null,
          "strength_mg": 0.05,
          "exact_strength": true,
          "exact_form": true,
          "discontinued": false,
          "also_contains": null
        },
        {
          "trade_name": "FLIXOTIDE EVOHALER 50MCG/ACTUATION INHALER",
          "scientific_name": null,
          "normalized_ingredient": null,
          "manufacturer": "GLAXO SMITHKLINE",
          "price_egp": 111.0,
          "pack_count": null,
          "unit_price": null,
          "strength_mg": 0.05,
          "exact_strength": true,
          "exact_form": true,
          "discontinued": false,
          "also_contains": null
        }
      ],
      "condition_id": "obstructive-sleep-apnoea"
    }
  ]
}