Treatment options in obstructive sleep apnea

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Abstract

Treatment of OSA with CPAP is currently the recommended treatment and has the greatest evidence of efficacy on AHI, symptoms and comorbidities. Symptomatic patients with moderate-severe OSA generally have good adherence to CPAP therapy, while those with mild OSA, female, young and generally paucisymptomatic, have lower CPAP adherence, especially in the medium and long term. The recent identification of different clinical and pathophysiological phenotypes of OSA has paved the way for alternative treatments to CPAP, leading to an increasingly personalized therapy. Weight loss and lifestyle modifications are highly recommended in all obese or overweight patients. Mandibular advancement devices (MAD), positional therapy (PT) and hypoglossal nerve stimulation (HSN) are recent and personalized alternative therapies on which there is promising and encouraging data but with still little strong scientific evidence. The purpose of this review is to compare the efficacy, adherence and costs of various therapeutic options for OSA patients in the light of recent evidence and to provide useful guidance for specialists.

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Obstructive sleep apnoea syndrome.

Patrick Levy, Malcolm Kohler, Walter McNicholas … (2015)

Obstructive sleep apnoea syndrome (OSAS) is a common clinical condition in which the throat narrows or collapses repeatedly during sleep, causing obstructive sleep apnoea events. The syndrome is particularly prevalent in middle-aged and older adults. The mechanism by which the upper airway collapses is not fully understood but is multifactorial and includes obesity, craniofacial changes, alteration in upper airway muscle function, pharyngeal neuropathy and fluid shift towards the neck. The direct consequences of the collapse are intermittent hypoxia and hypercapnia, recurrent arousals and increase in respiratory efforts, leading to secondary sympathetic activation, oxidative stress and systemic inflammation. Excessive daytime sleepiness is a burden for the majority of patients. OSAS is also associated with cardiovascular co-morbidities, including hypertension, arrhythmias, stroke, coronary heart disease, atherosclerosis and overall increased cardiovascular mortality, as well as metabolic dysfunction. Whether treating sleep apnoea can fully reverse its chronic consequences remains to be established in adequately designed studies. Continuous positive airway pressure (CPAP) is the primary treatment modality in patients with severe OSAS, whereas oral appliances are also widely used in mild to moderate forms. Finally, combining different treatment modalities such as CPAP and weight control is beneficial, but need to be evaluated in randomized controlled trials. For an illustrated summary of this Primer, visit: http://go.nature.com/Lwc6te.

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Relationship between hours of CPAP use and achieving normal levels of sleepiness and daily functioning.

Terri Weaver, Greg Maislin, David Dinges … (2007)

Evidence suggests that, to maintain treatment effects, nasal continuous positive airway pressure (CPAP) therapy for obstructive sleep apnea (OSA) needs to be used every night. What remains unknown is the nightly duration of use required to normalize functioning. This study, employing probit analyses and piecewise regression to estimate dose-response functions, estimated likelihoods of return to normal levels of sleepiness and daily functioning relative to nightly duration of CPAP. Multicenter, quasi-experimental study. Seven sleep centers in the United States and Canada. Patients with severe OSA (total cohort n = 149; the numbers of included participants from 85 - 120, depending on outcome analyzed.) CPAP. Before treatment and again after 3 months of therapy, participants completed a day of testing that included measures of objective and subjective daytime sleepiness and functional status. There were significant differences in mean nightly CPAP duration between treatment responders and nonresponders across outcomes. Thresholds above which further improvements were less likely relative to nightly duration of CPAP were identified for Epworth Sleepiness Scale score (4 hours), Multiple Sleep Latency Test (6 hours), and Functional Outcomes associated with Sleepiness Questionnaire (7.5 hours). A linear dose-response relationship (P < 0.01) between increased use and achieving normal levels was shown for objective and subjective daytime sleepiness, but only up to 7 hours use for functional status. Our analyses suggest that a greater percentage of patients will achieve normal functioning with longer nightly CPAP durations, but what constitutes adequate use varies between different outcomes.

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Longitudinal study of moderate weight change and sleep-disordered breathing.

Paul Peppard (2000)

Excess body weight is positively associated with sleep-disordered breathing (SDB), a prevalent condition in the US general population. No large study has been conducted of the longitudinal association between SDB and change in weight. To measure the independent longitudinal association between weight change and change in SDB severity. Population-based, prospective cohort study conducted from July 1989 to January 2000. Six hundred ninety randomly selected employed Wisconsin residents (mean age at baseline, 46 years; 56% male) who were evaluated twice at 4-year intervals for SDB. Percentage change in the apnea-hypopnea index (AHI; apnea events + hypopnea events per hour of sleep) and odds of developing moderate-to-severe SDB (defined by an AHI > or =15 events per hour of sleep), with respect to change in weight. Relative to stable weight, a 10% weight gain predicted an approximate 32% (95% confidence interval [CI], 20%-45%) increase in the AHI. A 10% weight loss predicted a 26% (95% CI, 18%-34%) decrease in the AHI. A 10% increase in weight predicted a 6-fold (95% CI, 2.2-17.0) increase in the odds of developing moderate-to-severe SDB. Our data indicate that clinical and public health programs that result in even modest weight control are likely to be effective in managing SDB and reducing new occurrence of SDB.

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Author and article information

Contributors

Maria Rosaria Bonsignore:

ORCID: http://orcid.org/0000-0002-4875-7796

mariarosaria.bonsignore@unipa.it

Journal

Journal ID (nlm-ta): Intern Emerg Med

Journal ID (iso-abbrev): Intern Emerg Med

Title: Internal and Emergency Medicine

Publisher: Springer International Publishing (Cham )

ISSN (Print): 1828-0447

ISSN (Electronic): 1970-9366

Publication date (Electronic): 23 April 2022

Publication date PMC-release: 23 April 2022

Publication date (Print): 2022

Volume: 17

Issue: 4

Pages: 971-978

Affiliations

[1 ]GRID grid.417108.b, Division of Pulmonary Medicine, , Ospedali Riuniti Villa Sofia-Cervello, ; Via Trabucco 180, 90146 Palermo, Italy

[2 ]GRID grid.10776.37, ISNI 0000 0004 1762 5517, PROMISE Department, , University of Palermo, ; Palermo, Italy

Author information

Maria Rosaria Bonsignore http://orcid.org/0000-0002-4875-7796

Article

Publisher ID: 2983

DOI: 10.1007/s11739-022-02983-1

PMC ID: 9135849

PubMed ID: 35460431

SO-VID: bcb806a6-29c7-47e9-8c02-d61b0793267e

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Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.

History

Date received : 12 February 2022

Date accepted : 29 March 2022

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ScienceOpen disciplines: Emergency medicine & Trauma

Keywords: personalized medicine,clinical phenotypes,physiological phenotypes,cpap adherence,non-pap treatment

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ScienceOpen disciplines: Emergency medicine & Trauma

Keywords: personalized medicine, clinical phenotypes, physiological phenotypes, cpap adherence, non-pap treatment

Treatment options in obstructive sleep apnea

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Irish Journal of Paramedicine

Most cited references 65

Obstructive sleep apnoea syndrome.

Relationship between hours of CPAP use and achieving normal levels of sleepiness and daily functioning.

Longitudinal study of moderate weight change and sleep-disordered breathing.

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