Management of Obstructive Sleep Apnea

V K Vijayan

Abstract


Obstructive Sleep Apnea (OSA) is an important public health problem and is associated
with considerable morbidity and mortality. Therefore, treatment of this condition is of
paramount importance. The treatment of OSA includes general and behavioural
measures, mechanical measures including continuous positive airway pressure
(CPAP), Bilevel positive airway pressure (BiPAP) and Oral Appliances (OA),
pharmacological treatment and surgical procedures. Continuous positive airway
pressure (CPAP) treatment reverses the repetitive upper airway obstruction of sleep
apnea and associated daytime sleepiness and is the most effective treatment for OSA.
However maintaining patient adherence to CPAP therapy is a challenge. Weight loss
should be recommended to overweight patients with OSA, as it has been shown that
weight reduction has additional health benefits. Treatment of underlying medical
conditions such as hypothyroidism or acromegaly has profound effect on
apnea/hypopnea index. A subset of patients with OSA may benefit from supplemental
oxygen and positional therapy. Presently, there are no effective pharmacotherapeutic
agents for treatment of patients with OSA and the role of surgical treatment in OSA is
controversial. However, pharmacological treatment of persisting residual sleepiness,
despite adequate positive airway pressure therapy delivery and adherence, is indicated
and may improve daytime sleepiness.
Key words : CPAP, Oral appliances, Modafinil, CPAP compliance
Uvulopalatopharyngoplasty, positional therapy

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