An Overview of Obstructive Sleep Apnea Treatment
Continuous positive airway pressure (CPAP) therapy is usually the first treatment option medical doctors prescribe for patients with symptomatic and significant obstructive sleep apnea (OSA). There is a strong clinical documentation to support CPAP for symptomatic patients with moderate and severe OSA, and such treatment usually has positive neurobehavioral and cardiovascular outcomes if patients can use CPAP effectively and consistently. However, it is less clear how to treat patients with all disease severities who are not relatively asymptomatic or sleepy patients who are not compliant with CPAP therapy. For these patients, doctors should consider these options: including lifestyle modification, weight reduction, sleep positional modification, oral appliances, and upper airway surgery. currently, there is no reliably effective pharmacologic therapy for OSA.
Continuous Positive Airway Pressure
CPAP therapy for OSA was developed in the early 1980’s and soon became the first-choice therapy for symptomatic OSA by medical doctors. CPAP works by pneumatically splinting open the upper airway via the application of a positive pressure across the airway walls and thus preventing the narrowing (hypopnea) or complete collapse (apnea) of the airway during sleep. CPAP therapy can and should reduce the apnea-hypopnea index (AHI), to within the normal range. AHI is usually considered to be normal with fewer than 5 events per hour.
There is solid evidence showing that effective CPAP usage improves the neurobehavioral and cardiovascular consequences of OSA. Research confirms that sleepiness is lessened with CPAP. Plus, quality of life in sleep OSA patients are also improved by use of CPAP. Adverse cardiovascular consequences of untreated significant OSA appear to be lessened by patient’s use of CPAP.
Not all patients with OSA will accept or are able to tolerate CPAP. Even among sleepy patients who have moderate or more severe OSA, there is a substantial level of noncompliance with prescribed therapy-between 46% and 83%. It is important to note that successful compliance is defined as only four hours or more of average nightly usage.
Problems patients with CPAP experience:
- Unable to Get Comfortable Sleeping with Mask
- Skin Irritation
- Sore Nose
- Air Leaks
- Stomach Bloating
- Chest or Lung Pain
- Dry Mouth/Throat
- Nasal Congestion
Oral Appliances as an adjunct to CPAP can be used when patients travel when/where CPAP usage is impractical or impossible.
Conservative methods involving weight loss, alcohol moderation and smoking cessation are encouraged in patients with OSA. Weight loss has been shown to be advantageous in reducing the severity of OSA. Based on case study reports, major weight loss such as may occur over time after bariatric surgery can result in resolution of OSA. Sleep trained Dentist can make custom mouth pieces that open up the airway.
Positional therapy (eg, using a shirt that has a tennis ball sewn into the back of the shirt to prevent the patient from sleeping in the supine position) is most beneficial when OSA is predominantly supine in its occurrence. Positional therapy studies suggest only a partial OSA response.
Numerous pharmacologic approaches to treating OSA have been tried over many years. These have been shown to be minimally or not at all effective.
Upper airway surgery
There are many specific surgical approaches to the treatment of upper airway in OSA. Generally, these surgeries are reserved for patients who 1. have snoring with minimal OSA 2. who have failed or are unwilling to use other effective OSA treatments. The goal of upper airway surgery is tissue of the upper airway at any or all levels of anatomic narrowing.
The appropriative definitions of surgical “success” are controversial, and recent criticism of surgery for treatment of OSA have recognized the clear need for higher quality evidence and adequate definition of therapeutic effectiveness.
Many of the upper airway surgical procedures are connected with adverse effects, including bleeding, permanent tooth anesthesia, infection, and neuropathic pain. – Riley RW, Powell NB, Guilleminault C, et al. Obstructive Sleep Apnea surgery: Risk management and complications. Otolaryngol Head Neck Surg 1997; 1 17:648-652
Thus, it is important to establish more precise data about their effectiveness and the types of patients who might benefit from such treatment.