Deciding which of the various treatment options is most appropriate for the management of OSA depends on both the severity of the condition and the characteristics of an individual patient. Patients with mild OSA have a wider variety of options, while people with moderate-to-severe OSA should be treated with Continuous Positive Airway Pressure (CPAP). The most effective treatment for symptomatic OSA is CPAP; effectiveness of this treatment has been confirmed by a NICE Health Technology Assessment, which you can find below.
Continuous Positive Airway Pressure (CPAP) is a non-invasive technique for delivering high pressures of air from a flow generator, via a nasal of full face mask during sleep. The purpose is to stent the upper airway and prevent collapse of the oropharyngeal walls, thus preventing apnoea and improving sleep quality.
CPAP therapy is indicated for moderate to severe obstructive sleep apnoea, however if a patient with mild OSA has symptoms that affect their quality of life and daily activities, and when other relevant treatment options and advice have been unsuccessful, they might be trialled with CPAP.
CPAP therapy is associated with a number of beneficial effects which is the reason lots of patients tolerate this therapy. Unfortunately, there are some side effects which occasionally cannot be overcome. The most frequent side effect of CPAP treatment is intolerable drying of the mouth and upper airway. This can usually be resolved by adding a heated humidifier to the CPAP machine, which delivers the pressurised air via a chamber of distilled water. Patients are able to adjust the temperature of this chamber, which will alter the humidity of the air to their preference.
- Less excessive daytime sleepiness
- Better sleep quality
- Better QOL and improved mood
- Stops snoring
- Enhanced neurocognitive function
- Better blood pressure control
- Improved cardiac function in persons with congestive heart failure
- Decreased prevalence of atrial and ventricular arrhythmias, and less recurrence of atrial fibrillation
- Improved insulin sensitivity
- Gastric distention
- Disrupted sleep
- Dry mouth
- Facial skin irritation, rash or abrasion
- Eye irritation
- Mask and mouth leaks
- Nasal congestion, dryness, epistaxis or rhinorrhea, sinus discomfort or pain
- Noise from the device
Unlike most forms of medical treatment for chronic conditions, CPAP has the distinct advantage that use of the treatment can be continuously monitored. Such monitoring should be an essential component of periodic surveillance and is an important outcome to document as part of clinical audit.