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Non-CPAP therapies in obstructive sleep apnoea.

W J Randerath¹, J Verbraecken, S Andreas

¹Institute for Pneumology at the University Witten/Herdecke,Clinic for Pneumology and Allergology, Centre of Sleep Medicine and Respiratory Care, Bethanien Hospital, Solingen, Germany. randerath@klinik-bethanien.de

The European Respiratory Journal

|March 17, 2011

Summary

Mandibular advancement devices effectively treat mild to moderate obstructive sleep apnoea syndrome (OSAS). Maxillomandibular osteotomy offers an alternative to CPAP, while other surgical and non-surgical options show limited efficacy for OSAS.

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Area of Science:

Respiratory Medicine
Otolaryngology
Sleep Medicine

Background:

Obstructive sleep apnoea syndrome (OSAS) is prevalent and significantly impairs patients.
Numerous treatments are available, but their efficacy varies widely.
An evidence-based review is crucial for understanding effective OSAS management.

Purpose of the Study:

To summarize the efficacy of alternative treatment options for obstructive sleep apnoea syndrome (OSAS).
To provide an evidence-based evaluation of various OSAS interventions.

Main Methods:

An interdisciplinary European Respiratory Society task force conducted a literature review.
Evaluation followed the standards of evidence-based medicine.
Focus on alternative and surgical treatments for OSAS.

Main Results:

Mandibular advancement devices are supported for mild to moderate OSAS.
Maxillomandibular osteotomy is as effective as CPAP for patients refusing conservative care.
Distraction osteogenesis benefits congenital micrognathia/midface hypoplasia; weight reduction shows a trend towards improvement; positional therapy is inferior to CPAP with poor compliance.
Drugs, nasal dilators, and muscle stimulation lack proven efficacy.
Many single surgical interventions (nasal, tonsil, tongue base, etc.) are not recommended.
Uvulopalatopharyngoplasty, pillar implants, and hyoid suspension require careful patient selection.
Multilevel surgery is a salvage option for OSAS.

Conclusions:

Mandibular advancement devices and maxillomandibular osteotomy are effective OSAS treatments.
Many alternative therapies lack sufficient evidence or are less effective than CPAP.
Surgical interventions for OSAS require careful consideration of risks and benefits.