Treating obstructive sleep apnea with positive pressure therapy

Obstructive sleep apnea (OSA), a highly prevalent disorder, has historically been under-recognized. As its diagnosis and recognition increases, physicians other than sleep specialists will need to gain familiarity with the management of this disorder, which is so closely tied to increased morbidity, mortality, and an overall health care burden. Most patients with OSA have been managed primarily with positive airway pressure, which is the focus of this review. The technology of positive airway pressure devices has advanced in order to improve adherence. For example, devices are now more compact and lighter in weight, less noisy, have heated humidification capability to diminish nasal dryness and congestion, have an increased variety of mask interfaces, and have modalities to minimize issues of pressure intolerance. In our practice, a multifaceted management model consisting of behavioral modification incorporating weight loss education, sleep hygiene education, and avoidance of exacerbating factors such as alcohol is usually employed in addition to positive airway pressure. A key component to effective treatment is close follow-up with troubleshooting if positive airway pressure adherence issues arise. Observance of early adherence issues is key, so that problems can be addressed sooner and long-term compliance is assured. Also crucial in managing patients with OSA is education regarding potentially improved cardiovascular morbidity and mortality and better quality of life with improved alertness and less drowsy driving. Other therapies specific to OSA, such as oral appliances or upper airway surgery, are discussed as alternatives to positive airway pressure, but these are typically pursued only if the patient has a strong preference or if positive airway pressure therapy is unsuccessful. As current therapies improve and emerging therapies continue to develop into viable treatment strategies, the successful management of OSA will likely demonstrate further progress.