Positive airway pressure therapy is widely regarded as the most effective way to treat OSA.1 It works by creating a "pneumatic splint" for the upper airway, preventing the soft tissues of the upper airway from narrowing and collapsing. Pressurised air is sent from a therapy device through air tubing and a mask that patients wear over their nose or mouth, through to the upper airway.
As a result of positive airway pressure therapy, a patient with severe sleep apnea may experience a return to a normal sleep pattern once his or her sleep debt resolves.
CPAP, APAP and bilevel therapy
Positive airway pressure therapy can be delivered in a number of modes:
Continuous positive airway pressure (CPAP) - which delivers pressurised air at one fixed pressure.
Automatic positive airway pressure (APAP) therapy - which automatically adjusts pressure levels based on a patient's breathing patterns. This may be particularly suited to patients with REM-related sleep apnea, positional apnea or those who are non-compliant with standard CPAP therapy.
Bilevel therapy - which provides higher inspiratory pressure (IPAP) and lower expiratory pressure (EPAP) - can also be effective for certain patients who are non-compliant, and used to treat a wide-range of respiratory disorders.
Oral appliance therapy
An oral appliance, often called a mandibular repositioning device (MRD), can be a second line therapy option and can be considered for patients with mild to moderate sleep apnoea. It is a custom-made, adjustable oral appliance available from a dentist that holds the lower jaw in a forward position during sleep. This mechanical protrusion expands the space behind the tongue, puts tension on the pharyngeal walls to reduce collapse of the airway and diminishes palate vibration.
Alternative treatment options
Surgery is also an option for treating sleep apnea, but as with all surgeries there are associated risks.
Uvulopalatopharyngoplastry (UPPP) has been widely used to treat snoring or OSA, but is not recommended as the first choice treatment option2. This surgical procedure involves the removal of the tonsils, soft palate/uvula and closure of the tonsillar pillars and certain risks are involved3.
Patient outcomes and comorbidities
Helping your patients start and continue with the most effective sleep apnea treatment can help them take back control of their lives. Effective treatment can help reverse the effects of daytime vigilance, cognitive dysfunction and mood disorders4. It is a source of lost productivity in the workplace5, 6 and increases motor vehicle accident risk.7, 8, 9
Epidemiology studies have also shown OSA to be independently associated with an increased risk of diabetes and cardiovascular disease, although no causal links.10, 11
Weaver T.E., et al. 2007 “Relationship between hours of CPAP Use and Achieving Normal levels of Sleepiness and Daily Function” Sleep, vol. 30, No. 6, pp. 711-719
2
Epstein L.J., et al. 2009 ‘Clinical Guideline for the Evaluation, amangement and long-term Care of Obstructive Sleep Apnea in Adults” Journal of Clinical Sleep Medicine, vol. 5, no. 3 pp. 263-276.
3
Effects and Side-Effects of Surgery for Snoring and Obstructive Sleep Apnea- A systematic Review (SLEEP, vol. 32, no.1 2009. 78
4
Hillman D.R., Lack L.C., 2013 ‘Public Health implications of sleep loss: the community burden’ Medical Journal of Australia vol. 199, no. 8 pp. S7-S10
5
Palnitkar G., Zimmermann S.C., & Cistulli P.A. 2012 ‘Obstructive Sleep Apnoea in adults: Identifying risk factors and tailoring therapy’, MedicineToday, vol. 13, no. 8, pp. 14-23.
6
Hillman D.R., Lack L.C., 2013 ‘Public Health implications of sleep loss: the community burden’ Medical Journal of Australia vol. 199, no. 8 pp. S7-S10
7
Stuuts J et al. Driver risk factors for sleep-related crashes. Accident Analysis and Prevention 35 2003
8
Ward K.L., et al. ‘Excessive Daytime Sleepiness Increases the risk of motor vehicle crash in Obstructive Sleep Apnea’ Journal of Clinical Sleep Medicine, 2013, vol. 9, no. 10 pp. 1013-1021
9
Tregear S., Et al. ‘Obstructive Sleep Apnea and Risk of motor Vehicle Crash:Systematic Review and Meta-Analysis’ Journal of Clinical Sleep Medicine, 2009, vol. 5, no. 6 pp. 573-581
10
Punjabi N.M., 2008 “The Epidemiology of Adult Obstructive Sleep Apnea” American Thoracic Society Journal, vol. 5, pp. 136-143.
11
Bradley, T.B., & Floras J.S. 2009 ‘Obstructive Sleep Apnoea and its cardiovascular consequences’ Lancet, vol. 373, pp. 82-93.
