Skip to main content
SpringerLink
Log in

Advances in the Treatment of Obstructive Sleep Apnea

  • Sleep Disorders (S Chokroverty, Section Editor)
  • Published:
Current Treatment Options in Neurology Aims and scope Submit manuscript

Opinion statement

This article focuses on the treatment of obstructive sleep apnea (OSA), using the most recent available data. The first choice of treatment for patients with moderate or severe obstructive sleep apnea is continuous positive airway pressure (CPAP), which was first described in 1981 (Sullivan et al. Lancet 1(8225):862-5, 1981) and works by splinting the airway open to facilitate proper airflow. For patients with mild OSA, other treatments may be considered including positional therapy, weight loss, or oral appliances. Oral appliances are continuing to become more mainstream, and may be a reasonable first-line treatment even for some patients with moderate OSA, such as those who cannot tolerate or do not want to use CPAP. Some evidence suggests that adherence to mandibular advancement devices (MADs), a type of oral appliance, may be superior to that of CPAP. Recent evidence has suggested that the MAD may be similar to CPAP in preventing cardiovascular mortality in OSA, though objective measurement of MAD adherence was not available in the study. Objective adherence monitors are now available for oral appliances and should prove valuable for clinicians. Pharmacotherapy has not been shown to be significantly effective in the treatment of OSA and should be considered as an adjunctive treatment class, though some emerging evidence may support pharmacotherapy for specific purposes, such as acetazolamide for high-altitude travelers and zonisamide for weight loss. Upper airway surgical intervention remains a second- or third-line treatment class for moderate to severe OSA, though multiple case series of maxillomandibular advancement (MMA) have shown considerable, statistically significant improvements in AHI. Weight loss should always be recommended for patients with OSA who are overweight or obese, as weight loss may result in improvement in OSA. Bariatric operations are effective for obesity and are reasonable considerations for obese patients, although a recent randomized controlled trial found that bariatric intervention failed to achieve superiority over conventional weight loss therapy in terms of apnea-hypopnea index (AHI) reduction.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References and Recommended Reading

  1. Punjabi NM. The epidemiology of adult obstructive sleep apnea. Proc Am Thorac Soc. 2008;5(2):136–43.

    Article  PubMed Central  PubMed  Google Scholar 

  2. Peppard PE, Young T, Barnet JH, Palta M, Hagen EW, Hla KM. Increased prevalence of sleep-disordered breathing in adults. Am J Epidemiol. 2013;177(9):1006–14.

    Article  PubMed Central  PubMed  Google Scholar 

  3. Peppard PE, Young T, Palta M, Dempsey J, Skatrud J. Longitudinal study of moderate weight change and sleep-disordered breathing. JAMA. 2000;284:3015–21.

    Article  CAS  PubMed  Google Scholar 

  4. Yaggi HK, Concato J, Kernan WN, Lichtman JH, Brass LM, Mohsenin V. Obstructive sleep apnea as a risk factor for stroke and death. N Engl J Med. 2005;353(19):2034–41.

    Article  CAS  PubMed  Google Scholar 

  5. Tuomilehto H, Seppä J, Uusitupa M, Peltonen M, Martikainen T, Sahlman J, et al. The impact of weight reduction in the prevention of the progression of obstructive sleep apnea: an explanatory analysis of a 5-year observational follow-up trial. Sleep Med. 2014;15(3):329–35.

    Article  PubMed  Google Scholar 

  6. Sarkhosh K, Switzer NJ, El-Hadi M, Birch DW, Shi X, Karmali S. The impact of bariatric surgery on obstructive sleep apnea: a systematic review. Obes Surg. 2013;23(3):414–23.

    Article  PubMed  Google Scholar 

  7. Dixon JB, Schachter LM, O'Brien PE, Jones K, Grima M, Lambert G, et al. Surgical vs conventional therapy for weight loss treatment of obstructive sleep apnea: a randomized controlled trial. JAMA. 2012;308(11):1142–9.

    Article  CAS  PubMed  Google Scholar 

  8. Qaseem A, Holty JE, Owens DK, Dallas P, Starkey M, Shekelle P, et al. Management of obstructive sleep apnea in adults: a clinical practice guideline from the American College of Physicians. Ann Intern Med. 2013. doi:10.7326/0003-4819-159-7-201310010-00704.

    Google Scholar 

  9. Eskandari D, Zou D, Karimi M, Stenlöf K, Grote L, Hedner J. Zonisamide reduces obstructive sleep apnoea: a randomised placebo-controlled study. Eur Respir J. 2014 Mar 13.

  10. Nussbaumer-Ochsner Y, Latshang TD, Ulrich S, Kohler M, Thurnheer R, Bloch KE. Patients with obstructive sleep apnea syndrome benefit from acetazolamide during an altitude sojourn: a randomized, placebo-controlled, double-blind trial. Chest. 2012;141(1):131–8.

    Article  CAS  PubMed  Google Scholar 

  11. Anttila SA, Leinonen EV. A review of the pharmacological and clinical profile of mirtazapine. CNS Drug Rev. 2001;7(3):249–64.

    Article  CAS  PubMed  Google Scholar 

  12. Carley D, Olopade C, Seink S, Radulovacki M. Efficacy of mirtazapine in obstructive sleep apnea syndrome. Sleep. 2007;30:35–41.

    PubMed  Google Scholar 

  13. Mason M, Welsh EJ, Smith I. Drug therapy for obstructive sleep apnoea in adults. Cochrane Database Syst Rev. 2013;5, CD003002.

    PubMed  Google Scholar 

  14. Marshall NS, Yee BJ, Desai AV, Buchanan PR, Wong KK, Crompton R, et al. Two randomized placebo-controlled trials to evaluate the efficacy and tolerability of mirtazapine for the treatment of obstructive sleep apnea. Sleep. 2008;31(6):824–31.

    PubMed Central  PubMed  Google Scholar 

  15. Moraes W, Poyares D, Sukys-Claudino L, et al. Donepezil improves obstructive sleep apnea in Alzheimer disease: a double-blind, placebo-controlled study. Chest. 2008;133:677–83.

    Article  CAS  PubMed  Google Scholar 

  16. Sukys-Claudino L, Moraes W, Guilleminault C, Tufik S, Poyares D. Beneficial effect of donepezil on obstructive sleep apnea: a double-blind, placebo-controlled clinical trial. Sleep Med. 2012;13(3):290–6.

    Article  PubMed  Google Scholar 

  17. Cichelero FT, Martinez D, Fuchs SC, Gus M, Moreira LB, Fuchs FD. The effect of antihypertensive agents on sleep apnea: protocol for a randomized controlled trial. Trials. 2014;15:1.

    Article  PubMed Central  PubMed  Google Scholar 

  18. Qaseem A, Holty JE, Owens DK, Dallas P, Starkey M, Shekelle P, for the Clinical Guidelines Committee of the American College of Physicians. Management of obstructive sleep apnea in adults: a clinical practice guideline from the American College of Physicians. Ann Intern Med. 2013 Sep 24.

  19. Camacho M, Certal V, Brietzke SE, Holty JE, Guilleminault C, Capasso R. Tracheostomy as treatment for adult obstructive sleep apnea: a systematic review and meta-analysis. Laryngoscope. 2014;124(3):803–11.

    Article  PubMed  Google Scholar 

  20. Fujita S, Conway W, Zorick F, Roth T. Surgical correction of anatomic abnormalities in obstructive sleep apnea syndrome: uvulopalatopharyngoplasty. Otolaryngol Head Neck Surg. 1981;89:923–34.

    CAS  PubMed  Google Scholar 

  21. Braga A, Grechi TH, Eckeli A, Vieira BB, Itikawa CE, Küpper DS, et al. Predictors of uvulopalatopharyngoplasty success in the treatment of obstructive sleep apnea syndrome. Sleep Med. 2013;14(12):1266–71.

    Article  PubMed  Google Scholar 

  22. Caples SM, Rowley JA, Prinsell JR, Pallanch JF, Elamin MB, Katz SG, et al. Surgical modifications of the upper airway for obstructive sleep apnea in adults: a systematic review and meta-analysis. Sleep. 2010;33:1396–407.

    PubMed Central  PubMed  Google Scholar 

  23. Kezirian EJ, Weaver EM, Yueh B, Deyo RA, Khuri SF, Daley J, et al. Incidence of serious complications after uvulopalatopharyngoplasty. Laryngoscope. 2004;114(3):450–3.

    Article  PubMed  Google Scholar 

  24. Franklin KA, Haglund B, Axelsson S, Holmlund T, Rehnqvist N, Rosén M. Frequency of serious complications after surgery for snoring and sleep apnea. Acta Otolaryngol. 2011;131(3):298–302.

    Article  PubMed  Google Scholar 

  25. Sullivan CE, Issa FG, Berthon-Jones M, Eves L. Reversal of obstructive sleep apnoea by continuous positive airway pressure applied through the nares. Lancet. 1981;1(8225):862–5.

    Article  CAS  PubMed  Google Scholar 

  26. Quan SF, Budhiraja R, Clarke DP, Goodwin JL, Gottlieb DJ, Nichols DA, et al. Impact of treatment with continuous positive airway pressure (CPAP) on weight in obstructive sleep apnea. J Clin Sleep Med. 2013;9(10):989–93.

    PubMed Central  PubMed  Google Scholar 

  27. Montesi SB, Edwards BA, Malhotra A, Bakker JP. The effect of continuous positive airway pressure treatment on blood pressure: a systematic review and meta-analysis of randomized controlled trials. J Clin Sleep Med. 2012;8:587–96.

    PubMed Central  PubMed  Google Scholar 

  28. Bakker JP, Edwards BA, Gautam SP, Montesi SB, Durán-Cantolla J, Aizpuru F, et al. Blood pressure improvement with continuous positive airway pressure is independent of obstructive sleep apnea severity. J Clin Sleep Med. 2014;10(4):365–9.

    PubMed  Google Scholar 

  29. Pépin JL, Tamisier R, Barone-Rochette G, Launois SH, Lévy P, Baguet JP. Comparison of continuous positive airway pressure and valsartan in hypertensive patients with sleep apnea. Am J Respir Crit Care Med. 2010;182(7):954–60.

    Article  PubMed  Google Scholar 

  30. Hastings PC, Vazir A, Meadows GE, Dayer M, Poole-Wilson PA, McIntyre HF, et al. Adaptive servo-ventilation in heart failure patients with sleep apnea: a real world study. Int J Cardiol. 2010;139(1):17–24.

    Article  PubMed  Google Scholar 

  31. Miyata M, Yoshihisa A, Suzuki S, Yamada S, Kamioka M, Kamiyama Y, et al. Adaptive servo ventilation improves Cheyne-Stokes respiration, cardiac function, and prognosis in chronic heart failure patients with cardiac resynchronization therapy. J Cardiol. 2012;60(3):222–7.

    Article  PubMed  Google Scholar 

  32. Oksenberg A. Positional and non-positional obstructive sleep apnea patients. Sleep Med. 2005;6:377–8.

    Article  PubMed  Google Scholar 

  33. Mador MJ, Kufel TJ, Magalang UJ, Rajesh SK, Watwe V, Grant BJ. Prevalence of positional sleep apnea in patients undergoing polysomnography. Chest. 2005;128(4):2130–7.

    Article  PubMed  Google Scholar 

  34. Oksenberg A, Silverberg DS, Arons E, Radwan H. Positional vs nonpositional obstructive sleep apnea patients: anthropomorphic, nocturnal polysomnographic, and multiple sleep latency test data. Chest. 1997;112(3):629–39.

    Article  CAS  PubMed  Google Scholar 

  35. Robin IG. Snoring. Proc R Soc Med. 1948;41:151–3.

    CAS  PubMed Central  PubMed  Google Scholar 

  36. Oksenberg A, Gadoth N. Are we missing a simple treatment for most adult sleep apnea patients? The avoidance of the supine sleep position. J Sleep Res. 2014;23(2):204–10.

    Article  PubMed  Google Scholar 

  37. Bignold JJ, Mercer JD, Antic NA, McEvoy RD, Catcheside PG. Accurate position monitoring and improved supine-dependent obstructive sleep apnea with a new position recording and supine avoidance device. J Clin Sleep Med. 2011;7:376–83.

    PubMed Central  PubMed  Google Scholar 

  38. VanMaanen JP, Meester KA, Dun LN, Koutsourelakis I, Witte BI, Laman DM, et al. The sleep position trainer: a new treatment for positional obstructive sleep apnoea. Sleep Breath. 2013;17:771–9.

    Article  Google Scholar 

  39. Oksenberg AS. Positional therapy for sleep apnea: a promising behavioral therapeutic option still waiting for qualified studies. Sleep Med Rev. 2014;18(1):3–5.

    Article  PubMed  Google Scholar 

  40. Kushida CA, Morgenthaler TI, Littner MR, et al. Practice parameters for the treatment of snoring and obstructive sleep apnea with oral appliances: an update for 2005. Sleep. 2006;29(2):240–3.

    PubMed  Google Scholar 

  41. Petri N, Svanholt P, Solow B, Wildschiodtz G, Winkel P. Mandibular advancement appliance for obstructive sleep apnoea: results of a randomised placebo controlled trial using parallel group design. J Sleep Res. 2008;17:221–9.

    Article  PubMed  Google Scholar 

  42. Gagnadoux F, Fleury B, Vielle B, Pételle B, Meslier N, N’Guyen XL, et al. Titrated mandibular advancement versus positive airway pressure for sleep apnoea. Eur Respir J. 2009;34:914–20.

    Article  CAS  PubMed  Google Scholar 

  43. Aarab G, Lobbezoo F, Heymans MW, Hamburger HL, Naeije M. Long-term follow-up of a randomized controlled trial of oral appliance therapy in obstructive sleep apnea. Respiration. 2011;82:162–8.

    Article  CAS  PubMed  Google Scholar 

  44. Sutherland K, Vanderveken OM, Tsuda H, Marklund M, Gagnadoux F, Kushida CA, et al. Oral appliance treatment for obstructive sleep apnea: an update. J Clin Sleep Med. 2014;10(2):215–27.

    PubMed  Google Scholar 

  45. Anandam A, Patil M, Akinnusi M, Jaoude P, El Solh AA. Cardiovascular mortality in obstructive sleep apnea treated with continuous positive airway pressure or oral appliance: an observational study. Respirology. 2013;18:1184–90.

    Article  PubMed  Google Scholar 

  46. Vanderveken OM, Dieltjens M, Wouters K, De Backer WA, Van de Heyning PH, Braem MJ. Objective measurement of compliance during oral appliance therapy for sleep-disordered breathing. Thorax. 2013;68:91–6.

    Article  PubMed Central  PubMed  Google Scholar 

  47. Haba-Rubio J, Andries D, Rey V, Michel P, Tafti M, Heinzer R. Effect of transnasal insufflation on sleep disordered breathing in acute stroke: a preliminary study. Sleep Breath. 2012;16(3):759–64.

    Article  PubMed  Google Scholar 

  48. Nilius G, Wessendorf T, Maurer J, Stoohs R, Patil SP, Schubert N, et al. Predictors for treating obstructive sleep apnea with an open nasal cannula system (transnasal insufflation). Chest. 2010;137(3):521–8.

    Article  PubMed  Google Scholar 

  49. Colrain IM, Black J, Siegel LC, Bogan RK, Becker PM, Farid-Moayer M, et al. A multicenter evaluation of oral pressure therapy for the treatment of obstructive sleep apnea. Sleep Med. 2013;14(9):830–7.

    Article  PubMed Central  PubMed  Google Scholar 

  50. Colrain IM, Brooks S, Black J. A pilot evaluation of a nasal expiratory resistance device for the treatment of obstructive sleep apnea. J Clin Sleep Med. 2008;4:426–33.

    PubMed Central  PubMed  Google Scholar 

  51. Rosenthal L, Massie CA, Dolan DC, Loomas B, Kram J, Hart RW. A multicenter, prospective study of a novel nasal EPAP device in the treatment of obstructive sleep apnea: efficacy and 30-day adherence. J Clin Sleep Med. 2009;5(6):532–7.

    PubMed Central  PubMed  Google Scholar 

  52. Berry RB, Kryger MH, Massie CA. A novel nasal expiratory positive airway pressure (EPAP) device for the treatment of obstructive sleep apnea: a randomized controlled trial. Sleep. 2011;34(4):479–85.

    PubMed Central  PubMed  Google Scholar 

  53. Strollo PJ, Soose RJ, Maurer JT, de Vries N, Cornelius J, Froymovich O, et al. Upper-airway stimulation for obstructive sleep apnea. N Engl J Med. 2014;370(2):139–49.

    Article  CAS  PubMed  Google Scholar 

  54. Guimarães KC, Drager LF, Genta PR, et al. Effects of oropharyngeal exercises on patients with moderate obstructive sleep apnea syndrome. Am J Respir Crit Care Med. 2009;179:962–6.

    Article  PubMed  Google Scholar 

  55. Puhan MA, Suarez A, Lo Cascio C, et al. Didgeridoo playing as alternative treatment for obstructive sleep apnoea syndrome: randomised controlled trial. BMJ. 2006;332:266–70.

    Article  PubMed Central  PubMed  Google Scholar 

  56. Marcus CL, Moore RH, Rosen CL, Childhood Adenotonsillectomy Trial (CHAT), et al. A randomized trial of adenotonsillectomy for childhood sleep apnea. N Engl J Med. 2013;368(25):2366–76.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  57. Goldbart AD, Greenberg-Dotan S, Tal A. Montelukast for children with obstructive sleep apnea: a double-blind, placebo-controlled study. Pediatrics. 2012;130(3):e575–80.

    Article  PubMed  Google Scholar 

  58. Kheirandish-Gozal L, Gozal D. Intranasal budesonide treatment for children with mild obstructive sleep apnea syndrome. Pediatrics. 2008;122(1):e149–55.

    Article  PubMed  Google Scholar 

  59. Kheirandish-Gozal L, Serpero LD, Dayyat E, Kim J, Goldman JL, Snow A, et al. Corticosteroids suppress in vitro tonsillar proliferation in children with obstructive sleep apnoea. Eur Respir J. 2009;33(5):1077–84.

    Article  CAS  PubMed  Google Scholar 

Download references

Compliance with Ethics Guidelines

Conflict of Interest David Young and Nancy Collop declare that they have no conflicts of interest.

Human and Animal Rights and Informed Consent This article does not contain any studies with human or animal subjects performed by any of the authors.

Author information

Authors and Affiliations

  1. Emory University, Atlanta, GA, USA

    David Young M.D. & Nancy Collop M.D.

Authors
  1. David Young M.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Nancy Collop M.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Nancy Collop M.D..

Additional information

This article is part of the Topical Collection on Sleep Disorders

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Young, D., Collop, N. Advances in the Treatment of Obstructive Sleep Apnea. Curr Treat Options Neurol 16, 305 (2014). https://doi.org/10.1007/s11940-014-0305-6

Download citation

  • Published:

  • DOI: https://doi.org/10.1007/s11940-014-0305-6

Keywords

Search

Navigation