Neurology Medical News about obstructive sleep apnea, clinical outcomes, positive airway pressure

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Treatment options for obstructive sleep apnea
Current Treatment Options in Neurology, 08/20/09

Abad VC et al. – A review of treatment options for obstructive sleep apnea discusses the use of oral appliances, clinical outcomes, and concerns for pediatric pts, with a focus on positive airway pressure (PAP) therapy as the gold standard adult treatment.

Methods

Review of obstructive sleep apnea treatment

Results

PAP therapy: continuous PAP (CPAP), bilevel PAP, autotitrating CPAP, or autotitrating bilevel PAP
Measures to increase PAP compliance: medical/surgical treatment of nasal obstruction, setting appropriate pressure level/airflow, mask selection/fitting, heated humidification, desensitization for claustrophobia, pt/partner education, follow-up with compliance software monitoring, and support groups
Adjunctive modalities: lifestyle/behavioral measures and pharmacologic therapy
Surgery for pts with significant upper airway obstruction unwilling/unable to tolerate PAP
Multilevel upper airway surgery for nose/oropharynx/hypopharynx obstruction
Systematic approach: phase 1) combined nose/oropharynx/hypopharynx surgery; phase 2) skeletal midface advancement or tracheotomy
Clinical outcomes: reassessed through attended diagnostic polysomnogram performed 3 to 6 months after surgery
Oral appliance use symptomatic mild or moderate sleep apnea pts whom PAP has failed, is intolerable, or is not preferred
Oral appliance use for severe obstructive sleep apnea pts unwilling/unable to tolerate PAP
Main treatment pediatric modality: tonsillectomy and adenoidectomy, with/without turbinate surgery

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