When continuous positive airway pressure (CPAP) fails.

Area of Science:

• Sleep Medicine
• Otolaryngology
• Public Health

Background:

• Obstructive sleep apnoea (OSA) prevalence is rising, exacerbated by the obesity epidemic, leading to significant health and economic burdens.
• Continuous positive airway pressure (CPAP) is the primary treatment for moderate to severe OSA, but patient compliance remains a challenge.
• Effective OSA management requires addressing treatment adherence and exploring alternative strategies.

Approach:

• This review discusses methods to enhance patient tolerance to CPAP therapy.
• It explores alternative non-surgical and surgical management options for OSA.
• The importance of upper airway evaluation by otolaryngologists for CPAP-intolerant patients is highlighted.

Key Points:

• Improving CPAP tolerance and exploring alternative treatments are crucial for managing OSA.
• Formal otolaryngological evaluation is recommended for patients who do not respond to CPAP.
• Identifying specific upper airway causes can guide site-specific surgical interventions.
• Careful patient selection is essential for successful treatment outcomes.
• A multidisciplinary team approach is necessary for comprehensive OSA patient management.

Conclusions:

• Addressing CPAP compliance and offering alternative therapies can improve OSA management.
• Surgical options guided by otolaryngological assessment offer potential benefits for select OSA patients.
• Multidisciplinary care optimizes outcomes for individuals with obstructive sleep apnoea.