From the Guidelines
Obstructive Sleep Apnea (OSA) Diagnosis and Treatment Sleep apnea is a sleep disorder characterized by recurrent episodes of partial or complete upper airway obstruction during sleep, resulting in disrupted sleep and decreased oxygen saturation, as defined by the American Academy of Sleep Medicine 1. The diagnosis of OSA is based on the presence of five or more predominantly obstructive respiratory events per hour of sleep during polysomnography (PSG) or per hour of monitoring time during a home sleep apnea test (HSAT) with symptoms or comorbidities 1.
Treatment Options
Treatment options for OSA include:
- Continuous Positive Airway Pressure (CPAP) Therapy: CPAP is the standard first-line treatment for OSA, which delivers compressed air into the airway to keep it open, as recommended by the American College of Physicians 1. The pressure is typically initiated at 5-10 cmH2O and titrated to an effective pressure of 10-15 cmH2O.
- Oral Appliances: Mandibular advancement devices (MADs) are an alternative therapy to CPAP for patients who prefer MADs or have adverse effects associated with CPAP, as suggested by the American College of Physicians 1.
- Behavioral Therapies: Weight loss, positional therapy, and avoidance of alcohol and sedatives before bedtime are recommended behavioral therapies, as stated by the European Respiratory Society 1 and the Portuguese Society of Pulmonology 1.
- Surgical Interventions: Surgical options, such as maxillofacial surgery or otolaryngologic surgery, may be considered for specific cases, as mentioned by the European Respiratory Society 1 and the Portuguese Society of Pulmonology 1.
Pharmacological Therapy
Pharmacological therapy with medications such as acetazolamide or modafinil may be considered to help manage symptoms, but the evidence is limited, and these medications are not recommended as a primary treatment for OSA, as stated by the American College of Physicians 1.
Key Considerations
- Patient education and adherence to therapy are crucial for effective OSA treatment, as emphasized by the American College of Physicians 1.
- A multidisciplinary team approach, including a qualified dentist, sleep unit, and sleep doctor, is recommended for discussing treatment options, as suggested by the Portuguese Society of Pulmonology 1.
From the FDA Drug Label
The effectiveness of modafinil tablets in improving wakefulness in patients with excessive sleepiness associated with OSA was established in two multi-center, placebo-controlled clinical studies of patients who met the criteria for OSA. The criteria for OSA include either: 1) excessive sleepiness or insomnia, plus frequent episodes of impaired breathing during sleep, and associated features such as loud snoring, morning headaches and dry mouth upon awakening; or 2) excessive sleepiness or insomnia and polysomnography demonstrating one of the following: more than five obstructive apneas, each greater than 10 seconds in duration, per hour of sleep and one or more of the following: frequent arousals from sleep associated with the apneas, bradytachycardia, and arterial oxygen desaturation in association with the apneas Modafinil tablets are indicated to improve wakefulness in adult patients with excessive sleepiness associated with narcolepsy, obstructive sleep apnea (OSA), or shift work disorder (SWD). Limitations of Use In OSA, modafinil tablets are indicated to treat excessive sleepiness and not as treatment for the underlying obstruction.
The diagnosis of Obstructive Sleep Apnea (OSA) is based on criteria that include excessive sleepiness or insomnia, plus frequent episodes of impaired breathing during sleep, and associated features such as loud snoring, morning headaches, and dry mouth upon awakening, or polysomnography demonstrating more than five obstructive apneas per hour of sleep. The treatment for OSA with modafinil tablets is indicated to improve wakefulness in adult patients with excessive sleepiness associated with OSA, but not as treatment for the underlying obstruction.
- Key points:
- Modafinil tablets are used to treat excessive sleepiness in OSA.
- Modafinil tablets are not a treatment for the underlying obstruction in OSA.
- Continuous positive airway pressure (CPAP) is the treatment of choice for OSA, and a maximal effort to treat with CPAP should be made prior to initiating and during treatment with modafinil tablets 2, 2.
From the Research
Diagnosis of Obstructive Sleep Apnea (OSA)
- The diagnosis of OSA requires the objective demonstration of abnormal breathing during sleep by measuring the respiratory disturbance index (RDI, events per hour of sleep) 3
- OSA is defined by combining symptoms and an RDI ≥5 or by an RDI ≥15 without symptoms 3
- The apnea-hypopnea index (AHI), the frequency of apnea and hypopnea events per hour of sleep, is widely used to define OSA 3, 4
- Minimal diagnostic criteria have been defined for OSAHS, including excessive daytime sleepiness and more than five obstructed breathing events per hour during sleep 4
Treatment Options for OSA
- Continuous positive airway pressure (CPAP) is the primary treatment for OSA 5, 6
- CPAP has been shown to provide benefit for not only the respiratory system, but also for the cardiovascular system and metabolic system 6
- Oral appliances are an alternative treatment for sleep apnoea, and have been shown to improve subjective sleepiness and sleep disordered breathing compared with a control 5
- However, nasal continuous positive airways pressure appears to be more effective in improving sleep disordered breathing than oral appliance 5
- Surgery is also an option for treating OSA, and has been shown to be effective in reducing symptoms of daytime sleepiness and improving AHI 5
Factors to Consider in Treatment
- Risk factors for OSA include obesity, upper airway abnormalities, male gender, menopause, and age 3
- Guidelines have been developed to tailor OSA therapy to patients according to the results of their disease evaluation and their preferences 3
- Adherence to treatment, particularly CPAP, can be a challenge, and strategies to improve adherence are needed 6