Treatment of Obstructive Sleep Apnea

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Written by Dr. Anitha Paderla, MBBS | Medically Reviewed by Dr. Sunil Shroff, MBBS, MS, FRCS (UK), D. Urol (Lond) on Feb 07, 2020
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Treatment of Obstructive Sleep Apnea

CPAP is found to be immensely beneficial to patients and therefore is a popular treatment for OSA. Nearly 55% of patients use it regularly in the night for at least 4 hours.

Patients may experience the following side- effects with the use of CPAP:

  • Skin problems
  • Nasal congestion
  • Dry eyes
  • Aerophagia (taking in too much air)
  • Dermatitis

b)Auto titration devices are helpful in enabling the least required pressure. It is also possible to alter the pressure according to the requirements of the patients at any desired time.

c)Bi-level positive airway pressure is a slightly different form of CPAP and employed when the patient is unable to adjust to CPAP. Since the air pressure needed to avoid respiratory obstruction is less on expiration, the bi-level positive airway pressure machines are equipped to change the pressure according to the patient’s inhalation and exhalation.

3.Oral Appliances

Oral appliances are not as consistently successful as CPAP treatment, but they may be useful in selected patients, with mild sleep apnea, who cannot tolerate CPAP or do not want to undergo surgery. Oral appliances which are employed for the treatment of OSA are available in two types :mandibular advance devices and tongue-retaining devices.

a)Mandibular advance devices look very similar to the athletic mouth guards employed in contact sports. Made of plastic, these devices help in opening the airway by keeping the jawbone in a forward position. This is highly effective in mild forms of OSA.

b)Tongue-retaining devices also look like an athletic mouth guard. The device consists of a suction cup that fits in between the upper and lower teeth. The tongue rests in the cup and gets pulled in the front during the night. This position of the tongue helps in preventing any obstruction at the bottom of the tongue. Tongue-retaining devices may be recommended for patients who snore heavily, but do not have significant apnea.

These devices are useful in treatment of mild forms of OSA. Certain disadvantages with these devices could be salivating excessively and temporal mandibular joint pain.

4. Surgical Treatment

Patients who cannot tolerate CPAP may be candidates for surgical intervention to alleviate obstructive sleep apnea.

A procedure called 'Uvulopalatopharneoplasty (UP3)' is the most common surgical procedure for treating OSA. Uvulopalatopharneoplasty (UPPP) is beneficial in relieving snoring and could involve removing a part of the soft palate, uvula, and unwanted peripharyngeal tissues. In certain cases, the tonsils may also be removed. However, this procedure may not offer a complete solution for obstructive sleep apnea.

Laser-assisted uvulopalatoplasty (LAUP) is helpful in a series of office treatments and is more commonly used than UPPP.

Tonsil or adenoid enlargement may be behind OSA in children. In such cases tonsils and adenoids are removed surgically to alleviate OSA.

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See this recent publication that indicates that obstructive Sleep Apnea - Obstructive sleep apnea (OSA) is associated with coronary artery disease (CAD). We hypothesized that OSA is independently related to the risk of CAD or death from any cause. In this observational cohort study, patients referred for OSA underwent polysomnography, and subsequent CAD events (myocardial infarction, coronary angiography or bypass graft surgery) or death were recorded. Patients were divided into exposure (AHI 15) and comparison groups (AHI Increased Risk of Coronary Artery Disease and Death, Shah NA et al New Haven, CT

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