Treatments for OSA:

Treatments for sleep apnea vary from simple, noninvasive to complex and invasive. Treatments include the following:

Lifestyle changes

Weight loss: Decreasing the body weight reduces the amount of excess tissue in and around the airway. Small reductions in weight have been shown to improve the patient’s condition markedly. A reduction in the body mass index (BMI) to 30 or less can significantly reduce obstructive sleep events.

Avoiding the use of alcohol and sleeping pills prior to sleep will reduce the sheer number and duration of apneic events.

A change to a decubitus sleeping position may reduce the number of apneic episodes depending on the severity of the disease.

CPAP

CPAP is the most common form of treatment and the most effective for obstructive apnea.

The positive pressure splints the airway open preventing collapse.

The desired level of pressure is set on the machine and can be adjusted to achieve the optimum benefit. One clinical guideline for determining initial pressure for CPAP trials is to use an initial pressure equal to 1/2 the patient's neck size - ("what the heck-half the neck").

Newer machines have a rise function in which pressure starts low and slowly builds to the set level. This allows the patient to fall asleep a bit more comfortably before being subjected to the full amount of positive pressure.

To apply the positive pressure to the airway the patient is fitted with either a full facial mask, which covers the mouth and nose, or a nasal mask, which covers only the nose. Another alternative is to use nasal pillows to deliver the desired pressure.

Full face mask	Nasal mask	Monarch Nasal Mask
Nasal pillows	NPB Nasal Pillows - medium size

Oral Appliances

Fixtures that help maintain upper airway patency to relieve obstruction. These appliances can be uncomfortable and cause excessive salivation in some patients.

Surgical procedures

Surgical removal of tonsils and adenoids will serve to increase the size of the pharynx and to eliminate those possible obstructive structures.
Surgical removal of any tumors, growths or nasal polyps which may be obstructing the airway.
Correction of any physical abnormality such as jaw or tissue malformations relieves airflow obstruction in many patients who have sleep apnea.
Uvulopalatopharyngoplasty (UPPP) -Surgical revision of the uvula, tonsils, soft palate, and soft tissues of the oropharynx may provide significant relief of obstruction in selected patients.
Laser-assisted uvulopalatoplasty (LAUP) - Surgical revision of the uvula, tonsils and soft palate, using laser technology may also provide significant relief of obstruction in these patients.

In general these procedures can be expensive and have a very high failure rate.

Tracheostomy

Used in severe cases to bypass the upper airway where obstructions exist. Primarily indicated for patients with true central sleep apnea to deliver mechanical ventilation during sleep. The tracheostomy tube can be capped during normal daytime hours allowing the patient to breathe and speak normally.

 

Objectives

Definitions

Cause/Effects

Diagnosis

Polysomnography

Treatments

References

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