Treatment Options of OSA

Weight loss is an effective treatment for the obese patient. Weight loss studies have shown that as the body mass index (BMI) goes down, the Apnea Hypopnea Index (AHI) goes down as well. While generally effective, effective weight loss requires a life style change, which can be difficult to initiate, and even more difficult to sustain, and naturally, it has no effect on non-obese patients.

CPAP, or continuous positive airway pressure, is the most effective treatment for Obstructive Sleep Apnea. If used properly and consistently, it is highly effective in virtually every patient. There are several variants of CPAP, Bi-level CPAP (BIPAP), Auto CPAP, Etc.

Tonsillectomy and Adenoidectomy is the preferred treatment for children, and is almost always effective. The results for surgery in adults are mixed however. There are many different kinds of surgeries. Radio Frequency Ablation creates scarring to stiffen the palette. Splints can be inserted into the palette for the same reason. LAUPP or Laser Assisted Uvulo-Palato-Plasty, Mandibular Advancement – effective, but major surgery; and methods to tighten, advance, and tie down, or otherwise keep the tongue from falling back into the throat can be complicated procedures, to say the least. Surgical interventions typically measure success as a percentage reduction in the AHI. The AHI is often still above the threshold of OSA – and there is a fair chance of recurrence after several years. Still in all, surgery is a viable option, especially for the non-compliant CPAP user.

Oral appliances are worn at night, to temporarily advance the mandible. They may be used in conjunction with CPAP. The attitude of the sleep community regarding oral appliances is mixed, and this is an area of treatment that is still undergoing significant development. People are now beginning to look at the long-term consequences of wearing an oral appliance every night, such as changes in the teeth and jaw. There is one treatment not listed here: positional treatment. Sewing a tennis ball into the back of the nightshirt; this treatment has been largely discarded by the sleep community as being insufficiently effective, and also difficult to manage.

Of these treatments, CPAP is the overwhelming treatment of choice in the sleep community. Surgery would be suggested only after earnest trials of CPAP have proven ineffective. Drug therapy is the goal for many in the sleep community. There have been some promising early trials, but there is currently no drug treatment for Obstructive Sleep Apnea, and no compounds are near release that has an acceptable efficacy, or side effect profile.