Non-CPAP therapies in obstructive sleep apnoea

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.