Narrative review of contemporary treatment options in the care of patients with obstructive sleep apnoea

Abstract

Snoring and obstructive sleep apnoea (OSA) are increasingly common conditions, and confer a significant health and socioeconomic burden. Furthermore, untreated OSA represents a significant mortality risk. Patients require careful assessment, including detailed clinical history and examination, sleep study and drug-induced sleep endoscopy (DISE). Although nasal continuous positive airway pressure (nCPAP) is the gold standard treatment for moderate and severe OSA, multidisciplinary team assessment is often required to develop the best treatment plan for an individual, especially when nasal CPAP is poorly tolerated. There is a wide range of medical and surgical treatment options, and following appropriate patient selection and assessment, a focused site-specific, often multilevel, intervention is indicated. There is an increasing body of evidence in the literature supporting these multilevel interventions and with agreement on standardized outcome measures more trials are likely to improve the robustness of these data further.

Minimally Invasive Radiofrequency Surgery in Sleep-Disordered Breathing

“…Nasal obstruction is a contributing factor to sleep-disordered breathing in a number of patients [1]. This can be secondary to septal deviation, polyposis, or inferior turbinate hypertrophy.…”

“…The treatment of sleep-disordered breathing must be tailored to the individual. The initial management should include conservative measures, in the form of weight loss, reduction in alcohol, position therapy, and medical therapies such as topical nasal steroids [1]. More directed therapies such as mandible advancement devices and continuous positive airway pressure (CPAP) are useful in selected cases but limited by poor compliance.…”

Tailoring surgical interventions to treat obstructive sleep apnoea: one size does not fit all

“…As per F erguson et al . [ 33 ], at our institution and based on our experience, we group our patients into three categories in whom we would offer surgery based on AHI-stratified severity of OSA: 1) mild OSA with raised flow limitation indices (indicating resistance to airflow based on anatomical abnormalities) >15%; 2) moderate or severe OSA not tolerating CPAP and failing a trial of MAS (surgery being adjunctive to aid delivery and facilitation, and thereby compliance with CPAP); 3) moderate or severe OSA, not tolerating CPAP (surgery with curative intent, aiming to improve AHI to <15 events·h −1 ) [ 33 ]. DISE is imperative in patient selection/treatment planning as outlined previously, especially given the multilevel patterns of obstruction often seen in patients with OSA.…”

Drug‐Induced Sleep Endoscopy Upper Airway Collapse Patterns and Maxillomandibular Advancement

“…Mandibular advancement devices (MAD) and surgery are generally reserved for patients with mild to moderate OSA or CPAP failure. 6,7 Maxillomandibular advancement (MMA) is the most successful surgical intervention for OSA aside from tracheostomy. 8 MMA involves advancement of both jaws following a Le Fort 1 maxillary osteotomy in conjunction with a bilateral sagittal split osteotomy of the mandible.…”

“…Continuous positive airway pressure (CPAP) is generally regarded as the gold standard in the treatment of severe OSA. Mandibular advancement devices (MAD) and surgery are generally reserved for patients with mild to moderate OSA or CPAP failure . Maxillomandibular advancement (MMA) is the most successful surgical intervention for OSA aside from tracheostomy .…”