Management of sleep apnoea syndrome

Obstructive sleep apnoea is a chronic condition characterized by repetitive episodes of upper airway collapse during sleep, leading to sleep fragmentation. The management of sleep apnoea consists of general and specific measures. General measures should include weight loss in overweight patients; avoidance of alcohol during the evening hours; avoidance of any hypnotic drug. Specific measures may range from simple position training in patients with positional sleep apnoea (sleep apnoea appearing only when lying on the back) of slight severity; to oral appliances with the aim of creating a prognathism during sleep, to the introduction of a nasopharyngeal tube during sleep every night. When position training, oral appliances or a nasopharyngeal tube are used, their effect should be monitored by full night polysomnography. The best specific treatment for sleep apnoea is nasal continuous positive airway pressure. The main problem with nasal continuous positive airway pressure is the long-term compliance which should be assessed regularly over the years. In cases where nasal continuous positive airway pressure is not tolerated or compliance is bad, a surgical treatment can be proposed. Uvulopalatopharyngoplasty seems to give disappointing results. By contrast, maxillomandibular surgery is credited with the best results available as far as surgery is concerned, comparable to nasal continuous positive airway pressure.