Clinical Review

Treatments for Obstructive Sleep Apnea

Journal of Clinical Outcomes Management. 2016 April;23(4)

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Treatment Combinations and Phenotyping

It has been recently suggested that combining 2 or more of the above treatments might lead to greater decreases in AHI and greater improvements in subjective sleepiness [112,113]. In fact, one such treatment combination has occurred [114]. Both OA or positional therapy decrease AHI. However, the combination of an OA and positional therapy led to further significant decreases in AHI compared to when those treatments were used alone [114]. To correctly combine treatments, the patient will have to be “phenotyped” via polysomnography to discern the specific pathophysiology of the patient’s OSA. There are published reports of methods to phenotype patients according to their sleep positon, ventilation parameters, loop gain, arousal threshold, and upper airway gain, and if apneic events occur in REM or NREM sleep [40,115]. Defining these traits for individual OSA patients can lead to better efficacy and compliance of combination treatments for OSA. Combination treatment coupled with phenotyping are needed to try to reduce AHI to levels achieved with CPAP.

Conclusion

CPAP is the gold standard treatment because it substantially decreases the severity of OSA just by placing a mask over one’s face before going to sleep. However, it is not tolerable to continually have air forced into your upper airways, and new CPAP devices that heat and humidify the air, and auto titrate the pressure, have been developed to increase adherence rates, but with limited success. For all the treatments listed, a majority do not decrease the severity of OSA to levels achieved with CPAP. However, adherence rates are higher and therefore might, in the long-term, be a better option than CPAP. Some treatments involve invasive surgery to open or stabilize the upper airways, or to implant a stimulator, some treatments involve oral drugs with side effects, and some treatments involve placing appliances on your nose or in your mouth. And some treatments can be combined and individually tailored to the OSA patient via “phenotyping.” For all treatments, the benefits and risks need to be weighed by each patient. More importantly, more large randomized controlled studies on treatments or combination of treatments for OSA are needed using parameters such as treatment adherence, AHI, oxygen desaturation, subjective sleepiness, quality of life, and adverse events (both minor and major) to gauge treatment success in the short-term and long-term. Only then can OSA patients in partnership with their health care provider choose the best treatment option.

Corresponding author: Michael W. Calik, PhD, 845 S. Damen Ave (M/C 802), College of Nursing, Room 740, Chicago, IL 60612, mcalik@uic.edu.

Financial disclosures: None.