Other treatment options for OSA – ICST

Other treatment options for OSA

Although CPAP therapy is considered the optimal therapy for OSA, alternative forms of treatment are available and should be considered in patients who are unable to tolerate CPAP therapy.

Other treatment options include:

Patients should be given general advice on improving sleep hygiene by monitoring their own sleep-wake times, use of stimulant or depressant medications, exercise and diet.

This should be accessible to any patient where clinically appropriate, because weight loss has been shown to significantly improve and occasionally cure OSA. In few individuals with severe obesity and appropriate indications, bariatric surgery may be considered an effective treatment option for OSA.

Intraoral mandibular advancement devices fit over the upper and lower teeth and stabilise the upper airway by causing protrusion of the lower jaw. They range from simple “boil and bite” devices which can be purchased over the counter, to custom made devices supplied by specialist orthodontists. They are indicated for patients with simple snoring, UARS, mild to moderate OSA and occasionally in severe OSA. Their efficiency in treating OSA is less than the efficiency of CPAP, but for some patients they are a convenient alternative.

Tonsillectomy and adenoidectomy has a role in the management, and sometimes cure, of individuals (usually children) with significant lymph tissue hypertrophy. Surgery of the pharynx is not generally recommended as a treatment option for OSA, unless there is definitive craniofacial or upper airway abnormalities that can be resolved. Procedures to improve nasal patency are sometimes effective.

In patients whose obstructive apnoeic events occur almost exclusively in the supine position, there are novel techniques that prevent the patient lying on their back. These include positional vests and the sewing of tennis balls into the back of a pyjama top. Provided this recommendation is appropriate and the technique has the desired effect, patients are usually delighted with this as an alternative to CPAP therapy.

Unfortunately pharmacological treatments are only considered as an adjunct to primary therapies for OSA. Topical nasal steroids may resolve nasal congestion in patients with concurrent rhinitis, and Modafonil or Armodafonil may be considered to improve wakefulness in patients who are established on CPAP therapy but still experiencing residual daytime sleepiness.

Oxygen therapy is not alone indicated as a therapy for OSA but it may be used alongside CPAP therapy (through a special adaptor port) to improve any residual hypoxia. The delivery of oxygen should only be managed by a specialist nurses, doctors and physiologists who are able to measure arterial blood gases.

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