Is there an intervention for Obstructive Sleep Apnea (OSA)?

From the Guidelines

Yes, the most effective treatment for obstructive sleep apnea (OSA) is continuous positive airway pressure (CPAP) therapy, as recommended by the American College of Physicians 1. This treatment involves wearing a mask over the nose or mouth while sleeping, which delivers air pressure to keep the airway open. The benefits of CPAP therapy include improved sleep quality, reduced risk of cardiovascular disease, and enhanced overall quality of life. For patients who cannot tolerate CPAP therapy, alternative options such as mandibular advancement devices may be considered, as supported by evidence from the European Respiratory Journal 1. Key considerations for OSA treatment include:

• Weight loss for overweight and obese patients, as recommended by the American College of Physicians 1
• Lifestyle modifications, such as avoiding alcohol and sedatives before bedtime and sleeping on the side instead of the back
• Oral appliances that reposition the jaw and tongue for mild to moderate cases
• Surgical options, such as tissue removal, jaw repositioning, or implanting a hypoglossal nerve stimulator, in select cases. It is essential to note that untreated OSA can lead to serious health problems, including high blood pressure, heart disease, stroke, and excessive daytime sleepiness, which can significantly impact quality of life and safety. Therefore, CPAP therapy should be considered the first-line treatment for moderate to severe OSA, with alternative options reserved for patients who cannot tolerate or prefer other treatments.

From the Research

Interventions for Obstructive Sleep Apnea (OSA)

• There are several interventions that have been studied for the management of OSA, including:
  • Weight-loss Mediterranean diet/lifestyle intervention 2
  • Lifestyle interventions addressing diet, exercise-training, sleep hygiene, and/or tobacco/alcohol cessation 3
  • Interdisciplinary weight loss and lifestyle intervention including nutrition, exercise, sleep hygiene, and smoking and alcohol cessation 4, 5
  • Dietary/lifestyle intervention on top of standard care, such as continuous positive airway pressure (CPAP) therapy 2, 6, 5

Effectiveness of Interventions

• The studies suggest that these interventions can lead to significant improvements in OSA severity and symptomatology, including:
  • Reductions in apnea-hypopnea index (AHI) 2, 3, 6, 5
  • Improvements in oxygen desaturation index (ODI) and excessive daytime sleepiness (EDS) 3
  • Enhancements in sleep quality, daily functioning, and mood 4, 5
  • Reductions in body weight and improvements in body composition 6, 5
  • Improvements in cardiometabolic risk factors, such as blood pressure and blood biomarkers 5
  • Enhancements in health-related quality of life 5

Dose-Response Relationship

• The dose-response relationship between weight loss and improvements in OSA severity has been studied, with results suggesting that:
  • Even a small amount of weight loss (<5%) can reduce respiratory events 6
  • A weight loss of 5-10% can lead to significant improvements in OSA severity 6
  • A weight loss of ≥10% is necessary for reducing the prevalence of severe OSA 6

Interdisciplinary Weight Loss and Lifestyle Intervention

• The INTERAPNEA study found that an interdisciplinary weight loss and lifestyle intervention resulted in clinically meaningful and sustainable improvements in OSA severity and comorbidities, as well as health-related quality of life 5
• The intervention led to a 51% reduction in AHI at the intervention end point and a 57% reduction at 6 months after intervention 5
• The intervention also resulted in significant improvements in body weight, body composition, cardiometabolic risk factors, and health-related quality of life 5