From the Guidelines
Treatment for moderate obstructive sleep apnea (OSA) should begin with continuous positive airway pressure (CPAP) therapy, as it remains the gold standard and is strongly recommended by the American College of Physicians 1.
Key Considerations
- CPAP therapy involves the use of a machine that delivers pressurized air through a mask to keep the airway open during sleep, with pressure settings typically ranging from 5-15 cmH2O as determined by a sleep specialist.
- Patients should use CPAP for the entire duration of sleep each night for optimal results.
- Alternative options include oral appliances like mandibular advancement devices, which reposition the lower jaw forward to maintain airway patency and are particularly useful for patients who cannot tolerate CPAP, as supported by evidence from the European Respiratory Journal 1.
Additional Treatment Options
- Weight loss is strongly recommended for overweight patients, as a 10% reduction in body weight can significantly improve OSA severity.
- Positional therapy (avoiding sleeping on the back) may help patients whose apnea worsens in the supine position.
- Lifestyle modifications are also important, including avoiding alcohol and sedatives before bedtime, maintaining regular sleep schedules, and treating nasal congestion if present.
Importance of Follow-Up
- Regular follow-up with a sleep specialist is essential to monitor treatment effectiveness and make necessary adjustments.
- The goal of OSA treatment is to alleviate airway obstruction during sleep, and CPAP therapy has been shown to be effective in achieving this goal, with a strong recommendation from the American College of Physicians 1.
From the Research
Treatment Options for Moderate Obstructive Sleep Apnea (OSA)
The following treatment options are available for moderate obstructive sleep apnea (OSA):
- Continuous positive airway pressure (CPAP) therapy, which is the first-line treatment for patients with moderate or severe OSA 2, 3, 4, 5
- Oral appliances, such as mandibular advancement devices (MADs), which may be a reasonable first-line treatment for some patients with moderate OSA who cannot tolerate or do not want to use CPAP 2, 5
- Positional therapy, which may be considered for patients with mild OSA or as an adjunctive treatment for moderate OSA 2, 5
- Weight loss, which is highly recommended for all obese or overweight patients with OSA, as it may result in improvement in OSA 2, 5
- Bariatric operations, which may be considered for obese patients with OSA, although their effectiveness in reducing apnea-hypopnea index (AHI) is still being studied 2
- Upper airway surgical intervention, such as maxillomandibular advancement (MMA), which may be considered as a second- or third-line treatment for moderate to severe OSA 2
- Bilevel positive airway pressure (BPAP) therapy, which may be considered for patients who are poorly compliant with CPAP therapy or have associated hypoventilation 6
- Auto-adjusting positive airway pressure (PAP) devices, which may be used to treat OSA, especially in patients with complex sleep disordered breathing syndromes 3
- Hypoglossal nerve stimulation (HSN), which is a recent and personalized alternative therapy with promising data, although more research is needed to establish its efficacy 5