From the Guidelines
All patients diagnosed with Obstructive Sleep Apnea (OSA) should be treated with continuous positive airway pressure (CPAP) as the initial therapy, as it is a strong recommendation with moderate-quality evidence. This is based on the American College of Physicians' clinical practice guideline from 2013 1. The goal of OSA treatment is to alleviate airway obstruction during sleep, and CPAP devices are the standard first-line treatment, delivering compressed air into the airway to keep it open.
Diagnosis of OSA
OSA is a common disorder that affects persons in all age groups, especially middle-aged and elderly persons. The diagnosis of OSA is typically made through sleep studies, which evaluate the Apnea-Hypopnea Index (AHI) and other measures of sleep quality. The clinical outcomes evaluated for OSA diagnosis and treatment include cardiovascular disease, type 2 diabetes, death, sleep study measures, and quality of life.
Treatment Options for OSA
In addition to CPAP therapy, other treatment options for OSA include:
- Weight loss, which is strongly recommended for overweight and obese patients with OSA, although the evidence is low-quality 1
- Mandibular advancement devices, which can be used as an alternative therapy to CPAP for patients who prefer them or have adverse effects associated with CPAP, although the recommendation is weak and based on low-quality evidence 1
- Lifestyle changes, such as avoiding alcohol before bedtime, sleeping on your side, and treating nasal congestion, which can help alleviate mild OSA symptoms
- Oral appliances that reposition the jaw and tongue, which may be prescribed by dentists specializing in sleep medicine
- Surgical options, such as uvulopalatopharyngoplasty (UPPP) or hypoglossal nerve stimulation, which may be considered for severe cases unresponsive to other treatments.
Importance of Treatment
Left untreated, OSA increases the risk of high blood pressure, heart problems, type 2 diabetes, and daytime fatigue. If you experience loud snoring, gasping during sleep, morning headaches, or excessive daytime sleepiness, it is essential to consult a healthcare provider for proper diagnosis through sleep studies and appropriate treatment.
From the Research
Diagnosis of Obstructive Sleep Apnea (OSA)
- The gold standard for the diagnosis of sleep apnea is an overnight polysomnogram 2.
- Split-night studies are becoming increasingly common and allow for quicker implementation of therapy at a reduced cost 2.
Treatment Options for OSA
- Continuous positive airway pressure (CPAP) is the most efficacious and widely used therapy for OSA 3, 4, 2, 5.
- Bilevel positive airway pressure (BPAP) is potentially capable of treating OSA at a lower mean pressure than CPAP and can help augment ventilation via pressure support 3.
- Weight loss and lifestyle modifications are highly recommended in all obese or overweight patients 4, 6.
- Mandibular advancement devices (MAD), positional therapy (PT), and hypoglossal nerve stimulation (HSN) are recent and personalized alternative therapies with promising data but limited strong scientific evidence 4.
- A dietary/lifestyle intervention on top of standard care leads to greater improvements in OSA severity and symptomatology compared to standard care alone 6.
Treatment Considerations
- CPAP complications include nasal congestion or dryness, mask discomfort, and claustrophobia, which can be improved with heated humidifiers, newer types of masks, and nasal steroids 2.
- Bilevel positive-pressure therapy can be considered for patients who find it difficult to exhale against the consistently increased pressure of CPAP 3, 2.
- Treatment of OSA with CPAP has the greatest evidence of efficacy on apnea-hypopnea index (AHI), symptoms, and comorbidities 4.