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Treating OSA : C urrent and emerging therapies beyond CPAP
Author(s) -
LorenziFilho Geraldo,
Almeida Fernanda R.,
Strollo Patrick J.
Publication year - 2017
Publication title -
respirology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.857
H-Index - 85
eISSN - 1440-1843
pISSN - 1323-7799
DOI - 10.1111/resp.13144
Subject(s) - medicine , continuous positive airway pressure , obstructive sleep apnea , oral appliance , soft palate , anesthesia , mouthpiece , airway , surgery , dentistry
ABSTRACT Continuous positive airway pressure ( CPAP ) is the standard treatment for moderate‐to‐severe obstructive sleep apnoea ( OSA ). However, adherence to CPAP is limited and non‐ CPAP therapies are frequently explored. Oral appliance ( OA ) therapy is currently widely used for the treatment of snoring, mild, moderate and severe OSA . The most commonly used and studied OA consists of a maxillary and mandibular splint which hold the lower jaw forward during sleep. The efficacy of OA is inferior to CPAP ; however, the effectiveness as measured by sleepiness, quality of life, endothelial function and blood pressure is similar likely due to higher acceptance and subjective adherence. Upper airway stimulation augments neural drive by unilaterally stimulating the hypoglossal nerve. The Stimulation Therapy for Apnea Reduction ( STAR ) study enrolled 126 patients and demonstrated a 68% reduction in OSA severity. A high upfront cost and variable response are the main limitations. Oropharyngeal exercises consist of a set of isometric and isotonic exercises involving the tongue, soft palate and lateral pharyngeal wall. The collective reported trials ( n = 120) showed that oropharyngeal exercises can ameliorate OSA and snoring (~30–40%). Nasal EPAP devices consist of disposable one‐way resister valve. A systematic review ( n = 345) showed that nasal EPAP reduced OSA severity by 53%. The Winx device consists of a mouthpiece placed inside the oral cavity that is connected by tubing to a console that generates negative pressure. Winx may provide successful therapy for ~30–40% of OSA patients. In conclusion, several non‐ CPAP therapies to treat OSA are currently available.