For Surgical Approaches, Click Here
1. Behavioral Techniques and Oral / Dental Appliances. Appropriate behavioral
treatment should be implemented for all patients, even those requiring additional interventions. These measures
include weight loss, reduction of alcohol consumption, sleeping laterally, and cessation of smoking. Patients treated
with behavioral techniques should be reevaluated periodically after initiation of treatment. If they show improvement
with these simple techniques, then continued support and positive reinforcement is extremely helpful. Other therapies
are warranted for those patients who continue to experience symptoms.
In addition, oral or dental appliances may be an option for patients with mild sleep
apnea. Appliances have also been used for patients who snore but do not have sleep apnea. There are various devices
that displace the tongue forward or move the mandible to an anterior and forward position to open the airway. Reported
side effects of the devices include excessive salivation and temporomandibular joint discomfort. A dentist or orthodontist
experienced in the use of these devices should fit the patient, and a sleep study should be done after the device
is fitted to evaluate its effectiveness.
2. Continuous Positive Airway Pressure (CPAP). CPAP became commercially available
in 1981, and is now the most common initial therapy for moderate and severe OSA. This treatment is usually prescribed
after a sleep study has been performed, and a further study (CPAP titration) has determined the therapeutic level
of CPAP pressure required to reduce or eliminate sleep apnea. The patient must wear a sealed mask over the nose
(in some cases, nose and mouth) during sleep. The mask is connected to a blower forcing air through the nasal passages.
CPAP acts as a pneumatic splint by increasing the pressure and opening the upper airway.
While there is no doubt about its efficacy, compliance is variable and is usually quoted
to be 50-70% but tends to be higher in patients with severe symptoms. The most common reasons for discontinuing
CPAP are intolerance of the mask, nasal- related complaints, and the inconvenience of being connected to a machine.
Common side effects include nasal stuffiness, rhinitis, facial skin discomfort, and discomfort with the pressure.
Humidifiers, nasal steroids or decongestants, intranasal anticholinergics, or different
masks may relieve side effects. Variations in pressure application can offer patients options for improving comfort.
Assisting patients to focus on symptom reversal and working with home care companies to ensure proper- fitting
and effective equipment is essential. Ongoing improvements in mask and machine technology are likely to continue
to improve compliance.
CPAP is effective in reversing daytime somnolence and eliminating cardiopulmonary sequelae.
CPAP, used properly, produces rhythmic breathing, resulting in the patient feeling dramatically better and being
able to function more efficiently (awkward). Compared with no treatment or other treatment modalities, patients
treated with CPAP have a lower mortality rate.
Follow-up after the first month of CPAP treatment should include checking the status
of equipment, assessing patient symptoms and adherence, and assessing the status of coexisting conditions such
as hypertension. In patients who have achieved significant weight loss, the CPAP pressure may need to be adjusted.
Click Here for Clinical Signs
Click Here for Diagnosis of OSA
Click Here for Treatment of OSA
