Treatment of Obstructive Sleep Apnoea
Besides losing weight and sleep hygiene measures, the gold standard treatment used for treating OSA is continuous positive airway pressure (CPAP), especially in more severe cases.
Non-drug therapy
The non-pharmacological treatment of obstructive sleep apnea can be divided into three fundamental pillars:
Hygienic/dietary and postural measures. These measures form the initial treatment for patients with mild to moderate obstructive sleep apnea and no significant symptoms. Additionally, the following general recommendations are given to all patients with sleep apnoea:
Get enough sleep (8 hours) and follow a regular timetable.
Abstain from alcohol (primarily in the evenings) and smoking.
Obese patients should lose weight.
Treatment of any nasal obstructions.
Regular physical exercise (this can reduce the number of events by more than 30%).
Suppression of central nervous system depressants (benzodiazepines, narcotics and barbiturates).
Patients with mild to moderate SAHS who predominantly sleep on their backs can avoid this position while asleep with the aid of a device that stops them from turning over.
Treatment with continuous positive upper airway pressure (CPAP). In patients with moderate or severe OSA, or those with mild, but very symptomatic OSA, besides the general measures, the first-choice treatment is continuous positive airway pressure (CPAP). This is the only treatment funded by the public health system.
A CPAP device consists of a pump that generates and drives an airflow through tubing connected to a mask (nasal or full-face) fixed in place on the face with straps. The mask has a vent to prevent breathing the exhaled air. As a result of the air flow and venting from the mask, the system transfers pressurised air to the upper airways. This acts as a pneumatic wedge to stop the pharynx from collapsing while asleep; thus preventing apnoea and normalising the structure of sleep. Each patient requires a certain CPAP pressure, so the correct amount should be determined individually through a nighttime sleep study. There are various systems available to help set the correct CPAP level. CPAP is a safe, non-invasive and reversible device. There are no absolute contraindications for the use of CPAP.
Intraoral devices. In select cases, patients with mild or moderate obstructive sleep apnea may benefit from mandibular advancement devices (MADs).
These comprise splints that ease the jaw forwards and therefore increase the retropharyngeal space and prevent the jaw and tongue from falling backwards. MADs are particularly indicated in non-obese patients (BMI < 30) with predominantly positional apnoea (lying on back) and with mild/moderate apnoea.
Upper airway and maxillofacial surgery may be the treatment of choice in selected cases; for example, in patients with tonsillar hypertrophy or significant retrognathia.
Hypoglossal nerve stimulation may be useful in selected cases. It has been shown to be more effective in patients with a BMI ≤32 kg/m2 in whom circumferential collapse of the upper airway has been excluded. It is not routinely used in our setting. It requires surgical placement of an electrode in the hypoglossal nerve and a sensor in the intercostal region that detects respiratory cycles. This sensor is connected to a subcutaneous generator in the pectoral region that produces pulses transmitted to the electrode which stimulates the genioglossus muscle and induces protrusion of the tongue, improving upper airway collapse.
Drug therapy
Recently, there has been a growing interest in studying drugs that could be useful for the treatment of obstructive sleep apnoea (e.g. acetazolamide and hypnotic drugs). GLP-1 analogues, used in the treatment of obesity, have recently shown promise in potentially reducing apnoea and hypopnoea episodes by reducing weight. Despite their promising results, these drugs are not yet routinely used in clinical practice.
Treatment complications
Patients often experience mild side effects for the first few weeks while using CPAP. They are generally very mild, temporary and respond well to local measures, so patients should be monitored closely over the first few months. It is particularly important that individuals receive adequate training and education before starting to use CPAP.
Substantiated information by:
Published: 16 January 2020
Updated: 16 January 2020
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