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Medical Management of Obstructive Sleep Apnea

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Abstract

There are multiple medical treatment modalities for the management of obstructive sleep apnea. In this chapter, various treatment options are discussed. In the first section, positive airway pressure is described in detail, including different modalities of delivery and efficacy. The second section covers positional therapy and medication that are available to assist with the management of OSA. The third section focuses on weight loss and lifestyle modifications in regard to OSA. Finally, the last section describes the use and efficacy of oral appliance, or mandibular repositioning devices, for treating mild-to-moderate OSA.

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References

  1. Jordan AS, McSharry DG, Malhotra A. Adult obstructive sleep apnoea. Lancet. 2014;383(9918):736. Epub 2013 Aug 2.

    Article  PubMed  Google Scholar 

  2. Jonas DE, Amick HR, Feltner C, Weber RP, Arvanitis M, Stine A, Lux L, Harris RP. Screening for obstructive sleep apnea in adults: evidence report and systematic review for the US preventive services task force. JAMA. 2017;317(4):415.

    Article  PubMed  Google Scholar 

  3. Giles TL, Lesserson TJ, Smith BJ, White J, Wright J, Cates CJ. Continuous positive airways pressure for obstructive sleep apnoea in adults. Cochrane Database Syst Rev. 2006;(3):CD001106.

    Google Scholar 

  4. Martinez-Garcia MA, Capote F, Campos-Rodriguez F, et al. Effect of CPAP on blood pressure in patients with obstructive sleep apnea and resistant hypertension: the HIPARCO randomized clinical trial. JAMA. 2013;310(22):2407–15. https://doi.org/10.1001/jama.2013.281250.

    Article  CAS  PubMed  Google Scholar 

  5. Sharma SK, Agrawal S, Damodaran D, Sreenivas V, Kadhiravan T, Lakshmy R, Jagia P, Kumar A. CPAP for the metabolic syndrome in patients with obstructive sleep apnea. N Engl J Med. 2011;365(24):2277–86. https://doi.org/10.1056/NEJMoa1103944.

    Article  CAS  PubMed  Google Scholar 

  6. George CF. Reduction in motor vehicle collisions following treatment of sleep apnoea with nasal CPAP. Thorax. 2001;56(7):508–12.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  7. Epstein LJ, Kristo D, Strollo PJ Jr, et al., for the Adult Obstructive Sleep Apnea Task Force of the American Academy of Sleep Medicine. Clinical guideline for the evaluation, management and long-term care of obstructive sleep apnea in adults. J Clin Sleep Med. 2009;5(3):263.

    Google Scholar 

  8. Weaver TE, Maislin G, Dinges DF, et al. Relationship between hours of CPAP use and achieving normal levels of sleepiness and daily functioning. Sleep. 2007;30(6):711–9.

    Article  PubMed  PubMed Central  Google Scholar 

  9. Wolkove N, Baltzan M, Kamel H, et al. Long-term compliance with continuous positive airway pressure in patients with obstructive sleep apnea. Can Respir J. 2008;15(7):265–9.

    Article  Google Scholar 

  10. Mastromatto N, Killough N, Keenan B, Schwab R, Bergmann A, Simonsen S, Staley B, Bae C, Schutte-Rodin S. 1075 the effect of changing the first CPAP mask on compliance. Sleep. 2018;41(Suppl_1):A399–400. https://doi.org/10.1093/sleep/zsy061.1074.

    Article  Google Scholar 

  11. Shukla A, Aizer A, Holmes D, et al. Effect of obstructive sleep apnea treatment on atrial fibrillation recurrence. JACC Clin Electrophysiol. 2015;1(1–2):41–51. https://doi.org/10.1016/j.jacep.2015.02.014.

    Article  PubMed  Google Scholar 

  12. Peled N, Abinader EG, Pillar G, et al. Nocturnal ischemic events in patients with obstructive sleep apnea syndrome and ischemic heart disease: effects of continuous positive air pressure treatment. JACC. 1999;34(6):1744–9.

    Article  CAS  PubMed  Google Scholar 

  13. Kaneko Y, Floras JS, Usui K, et al. Cardiovascular effects of continuous positive airway pressure in patients with heart failure and obstructive sleep apnea. N Engl J Med. 2003;348(13):1233–41.

    Article  PubMed  Google Scholar 

  14. Ioachimescu OC, Anthony J Jr, Constantin T, et al. VAMONOS (Veterans Affairs’ Metabolism, Obstructed and Non-Obstructed Sleep) study: effects of CPAP therapy on glucose metabolism in patients with obstructive sleep apnea. J Clin Sleep Med. 2017;13(3):455–66. https://doi.org/10.5664/jcsm.6502.

    Article  PubMed  PubMed Central  Google Scholar 

  15. Edwards C, Mukherjee S, Simpson L, et al. Depressive symptoms before and after treatment of obstructive sleep apnea in men and women. J Clin Sleep Med. 2015;11(9):1029–38. https://doi.org/10.5664/jcsm.5020.

    Article  PubMed  PubMed Central  Google Scholar 

  16. Eijsvogel MM, Ubbink R, Dekker J, Oppersma E, de Jongh FH, van der Palen J, Brusse-Keizer MG. Sleep position trainer versus tennis ball technique in positional obstructive sleep apnea syndrome. J Clin Sleep Med. 2015;11(2):139–47.

    Article  PubMed  PubMed Central  Google Scholar 

  17. 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(4):376–83.

    Article  PubMed  PubMed Central  Google Scholar 

  18. Levendowski DJ, Seagraves S, Popovic D, Westbrook PR. Assessment of a neck-based treatment and monitoring device for positional obstructive sleep apnea. J Clin Sleep Med. 2014;10(8):863–71.

    Article  PubMed  PubMed Central  Google Scholar 

  19. Matthews L, Fortier N. The Rematee Bumper Belt® positional therapy device for snoring and obstructive sleep apnea: positional effectiveness in healthy subjects. Can J Respir Ther. 2013;49:11–4.

    PubMed  PubMed Central  Google Scholar 

  20. Cartwright R, et al. A comparative study of treatments for positional sleep apnea. Sleep. 1991;14:546–52.

    Article  CAS  PubMed  Google Scholar 

  21. Jackson M, et al. Efficacy of sleep position modification to treat positional obstructive sleep apnea. Sleep Med. 2015;16:545–52.

    Article  PubMed  Google Scholar 

  22. Skinner MA, et al. Efficacy of the ‘tennis ball technique’ versus nCPAP in the management of position-dependent obstructive sleep apnoea syndrome. Respirology. 2008;13:708–15.

    Article  PubMed  Google Scholar 

  23. Jokic R, et al. Positional treatment vs continuous positive airway pressure in patients with positional obstructive sleep apnea syndrome. Chest. 1999;115:771–81.

    Article  CAS  PubMed  Google Scholar 

  24. Ravesloot MJ, White D, Heinzer R, Oksenberg A, Pépin JL. Efficacy of the new generation of devices for positional therapy for patients with positional obstructive sleep apnea: a systematic review of the literature and meta-analysis. J Clin Sleep Med. 2017;13(6):813–24.

    Article  PubMed  PubMed Central  Google Scholar 

  25. Mason M, Welsh EJ, Smith I. Drug therapy for obstructive sleep apnea in adults. Cochrane Database of Syst Rev. 2013;(5):CD003002. https://doi.org/10.1002/14651858.CD003002.pub3.

  26. Eskandari D, Zou D, Grote L, Hoff E, Hedner J. Acetazolamide reduces blood pressure and sleep-disordered breathing in patients with hypertension and obstructive sleep apnea: a randomized controlled trial. J Clin Sleep Med. 2018;14(3):309–17.

    Article  PubMed  PubMed Central  Google Scholar 

  27. Carley DW, Prasad B, Reid KJ, Malkani R, Attarian H, Abbott SM, Vern B, Xie H, Yuan C, Zee PC. Pharmacotherapy of apnea by cannabimimetic enhancement, the PACE clinical trial: effects of dronabinol in obstructive sleep apnea. Sleep. 2018;41(1):zsx184. https://doi.org/10.1093/sleep/zsx184.

    Article  Google Scholar 

  28. Babson KA, Sottile J, Morabito D. Cannabis, cannabinoids, and sleep: a review of the literature. Curr Psychiatry Rep. 2017;19:23.

    Article  PubMed  Google Scholar 

  29. Hales CM, Carroll MD, Fryar CD, Ogden CL. Prevalence of obesity among adults and youth: United States, 2015–2016. NCHS Data Brief. 2017;(288):1–8.

    Google Scholar 

  30. Ogden CL, Carroll MD, Fryar CD, Flegal KM. Prevalence of obesity among adults and youth: United States, 2011–2014. NCHS Data Brief. 2015;(219):1–8.

    Google Scholar 

  31. Schwartz AR, Patil SP, Laffan AM, Polotsky V, Schneider H, Smith PL. Obesity and obstructive sleep apnea: pathogenic mechanisms and therapeutic approaches. Proc Am Thorac Soc. 2008;5:185–92. https://doi.org/10.1513/pats.200708-137MG.

    Article  PubMed  PubMed Central  Google Scholar 

  32. Romero-Corral A, Caples SM, Lopez-Jimenez F, Somers VK. Interactions between obesity and obstructive sleep apnea: implications for treatment. Chest. 2010;137:711–9. https://doi.org/10.1378/chest.09-0360.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  33. Owens RL, Shafazand S. Effects of CPAP and weight loss on OSA outcomes. J Clin Sleep Med. 2014;10:1365–7. https://doi.org/10.5664/jcsm.4308.

    Article  PubMed  PubMed Central  Google Scholar 

  34. Schwartz AR, Gold AR, Schubert N, Stryzak A, Wise RA, Permutt S, Smith PL. Effect of weight loss on upper airway collapsibility in obstructive sleep apnea. Am Rev Respir Dis. 1991;144:494–8. https://doi.org/10.1164/ajrccm/144.3_Pt_1.494.

    Article  CAS  PubMed  Google Scholar 

  35. Smith PL, Gold AR, Meyers DA, Haponik EF, Bleecker ER. Weight loss in mildly to moderately obese patients with obstructive sleep apnea. Ann Intern Med. 1985;103:850–5.

    Article  CAS  PubMed  Google Scholar 

  36. 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;23:414–23. https://doi.org/10.1007/s11695-012-0862-2.

    Article  PubMed  Google Scholar 

  37. Priyadarshini P, Singh VP, Aggarwal S, Garg H, Sinha S, Guleria R. Impact of bariatric surgery on obstructive sleep apnoea-hypopnea syndrome in morbidly obese patients. J Minim Access Surg. 2017;13:291–5. https://doi.org/10.4103/jmas.JMAS_5_17.

    Article  PubMed  PubMed Central  Google Scholar 

  38. Joosten SA, Hamilton GS, Naughton MT. Impact of weight loss management in OSA. Chest. 2017;152:194–203. https://doi.org/10.1016/j.chest.2017.01.027.

    Article  PubMed  Google Scholar 

  39. Lettieri CJ, Eliasson AH, Greenburg DL. Persistence of obstructive sleep apnea after surgical weight loss. J Clin Sleep Med. 2008;4:333–8.

    Article  PubMed  PubMed Central  Google Scholar 

  40. Sawyer AM, Gooneratne NS, Marcus CL, Ofer D, Richards KC, Weaver TE. A systematic review of CPAP adherence across age groups: clinical and empiric insights for developing CPAP adherence interventions. Sleep Med Rev. 2011;15:343–56. https://doi.org/10.1016/j.smrv.2011.01.003.

    Article  PubMed  PubMed Central  Google Scholar 

  41. Chirinos JA, Gurubhagavatula I, Teff K, Rader DJ, Wadden TA, Townsend R, Foster GD, Maislin G, Saif H, Broderick P, Chittams J, Hanlon AL, Pack AI. CPAP, weight loss, or both for obstructive sleep apnea. N Engl J Med. 2014;370:2265–75. https://doi.org/10.1056/NEJMoa1306187.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  42. McEvoy RD, Antic NA, Heeley E, Luo Y, Ou Q, Zhang X, Mediano O, Chen R, Drager LF, Liu Z, Chen G, Du B, McArdle N, Mukherjee S, Tripathi M, Billot L, Li Q, Lorenzi-Filho G, Barbe F, Redline S, Wang J, Arima H, Neal B, White DP, Grunstein RR, Zhong N, Anderson CS. CPAP for prevention of cardiovascular events in obstructive sleep apnea. N Engl J Med. 2016;375:919–31. https://doi.org/10.1056/NEJMoa1606599.

    Article  PubMed  Google Scholar 

  43. 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. https://doi.org/10.1093/sleep/29.2.240.

    Article  PubMed  Google Scholar 

  44. Phillips CL, Grunstein RR, Darendeliler MA, et al. Health outcomes of continuous positive airway pressure versus oral appliance treatment for obstructive sleep apnea: a randomized controlled trial. Am J Respir Crit Care Med. 2013;187(8):879–87. https://doi.org/10.1164/rccm.201212-2223OC.

    Article  PubMed  Google Scholar 

  45. Fitzpatrick MF, McLean H, Urton AM, Tan A, O’Donnell D, Driver HS. Effect of nasal or oral breathing route on upper airway resistance during sleep. Eur Respir J. 2003;22(5):827–32. https://doi.org/10.1183/09031936.03.00047903.

    Article  CAS  PubMed  Google Scholar 

  46. Correa LP. Overview of oral appliance therapy for the management of obstructive sleep apnea. Sleep Med Clin. 2013;8(4):505–16. https://doi.org/10.1016/j.jsmc.2013.07.007.

    Article  Google Scholar 

  47. Sutherland K, Chan ASL, Cistulli PA. Three-dimensional assessment of anatomical balance and oral appliance treatment outcome in obstructive sleep apnoea. Sleep Breath. 2016;20(3):903–10. https://doi.org/10.1007/s11325-015-1304-x.

    Article  PubMed  Google Scholar 

  48. Edwards BA, Eckert DJ, Jordan AS. Obstructive sleep apnoea pathogenesis from mild to severe: is it all the same? Respirology. 2017;22(1):33–42. https://doi.org/10.1111/resp.12913.

    Article  PubMed  Google Scholar 

  49. Marklund M. Update on oral appliance therapy for OSA. Curr Sleep Med Rep. 2017;3(3):143–51. https://doi.org/10.1007/s40675-017-0080-5.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  50. Norrhem N, Marklund M. An oral appliance with or without elastic bands to control mouth opening during sleep—a randomized pilot study. Sleep Breath. 2016;20(3):929–38. https://doi.org/10.1007/s11325-016-1312-5.

    Article  PubMed  Google Scholar 

  51. Deane SA, Cistulli PA, Ng AT, Zeng B, Petocz P, Darendeliler MA. Comparison of mandibular advancement splint and tongue stabilizing device in obstructive sleep apnea: a randomized controlled trial. Sleep. 2009;32(5):648–53. https://doi.org/10.1093/sleep/32.5.648.

    Article  PubMed  PubMed Central  Google Scholar 

  52. Bagheri SC. Clinical review of oral and maxillofacial surgery: a case-based approach. 2nd ed. St. Louis: Elsevier/Mosby; 2014. https://doi.org/10.1016/C2012-0-02809-8.

    Book  Google Scholar 

  53. Takaesu Y, Tsuiki S, Kobayashi M, Komada Y, Nakayama H, Inoue Y. Mandibular advancement device as a comparable treatment to nasal continuous positive airway pressure for positional obstructive sleep apnea. J Clin Sleep Med. 2016;12(8):1113–9. https://doi.org/10.5664/jcsm.6048.

    Article  PubMed  PubMed Central  Google Scholar 

  54. Sutherland K, Takaya H, Qian J, Petocz P, Ng AT, Cistulli PA. Oral appliance treatment response and polysomnographic phenotypes of obstructive sleep apnea. J Clin Sleep Med. 2015;11(8):861–8. https://doi.org/10.5664/jcsm.4934.

    Article  PubMed  PubMed Central  Google Scholar 

  55. Serra-Torres S, Bellot-Arcís C, Montiel-Company JM, Marco-Algarra J, Almerich-Silla JM. Effectiveness of mandibular advancement appliances in treating obstructive sleep apnea syndrome: a systematic review. Laryngoscope. 2016;126(2):507–14. https://doi.org/10.1002/lary.25505.

    Article  PubMed  Google Scholar 

  56. Marklund M, Stenlund H, Franklin KA. Mandibular advancement devices in 630 men and women with obstructive sleep apnea and snoring: tolerability and predictors of treatment success. Chest. 2004;125(4):1270–8. https://doi.org/10.1378/chest.125.4.1270.

    Article  PubMed  Google Scholar 

  57. Edwards BA, Andara C, Landry S, et al. Upper-airway collapsibility and loop gain predict the response to oral appliance therapy in patients with obstructive sleep apnea. Am J Respir Crit Care Med. 2016;194(11):1413–22. https://doi.org/10.1164/rccm.201601-0099OC.

    Article  PubMed  PubMed Central  Google Scholar 

  58. Sasao Y, Nohara K, Okuno K, Nakamura Y, Sakai T. Videoendoscopic diagnosis for predicting the response to oral appliance therapy in severe obstructive sleep apnea. Sleep Breath. 2014;18(4):809–15. https://doi.org/10.1007/s11325-014-0947-3.

    Article  PubMed  Google Scholar 

  59. Cunali PA, Almeida FR, Santos CD, et al. Mandibular exercises improve mandibular advancement device therapy for obstructive sleep apnea. Sleep Breath. 2011;15(4):717–27. https://doi.org/10.1007/s11325-010-0428-2.

    Article  PubMed  Google Scholar 

  60. González M, Macias-Escalada E, Cobo J, et al. Can treatment with statins have a negative influence on the tolerance of mandibular advancement devices? Sleep Breath. 2016;20(4):1363–6. https://doi.org/10.1007/s11325-016-1399-8.

    Article  PubMed  Google Scholar 

  61. Marklund M. Long-term efficacy of an oral appliance in early treated patients with obstructive sleep apnea. Sleep Breath. 2016;20(2):689–94. https://doi.org/10.1007/s11325-015-1280-1.

    Article  PubMed  Google Scholar 

  62. Pantin CC, Hillman DR, Tennant M. Dental side effects of an oral device to treat snoring and obstructive sleep apnea. Sleep. 1999;22(2):237–40. https://doi.org/10.1093/sleep/22.2.237.

    Article  CAS  PubMed  Google Scholar 

  63. El-Solh AA, Moitheennazima B, Akinnusi ME, Churder PM, Lafornara AM. Combined oral appliance and positive airway pressure therapy for obstructive sleep apnea: a pilot study. Sleep Breath. 2011;15:203–8. https://doi.org/10.1007/s11325-010-0437-1.

    Article  PubMed  Google Scholar 

  64. Dieltjens M, Vroegop AV, Verbruggen AE, et al. A promising concept of combination therapy for positional obstructive sleep apnea. Sleep Breath. 2014;19(2):637–44. https://doi.org/10.1007/s11325-014-1068-8.

    Article  PubMed  PubMed Central  Google Scholar 

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Authors and Affiliations

  1. Pulmonary Disease and Critical Care Medicine, Department of Medicine, College of Medicine, University of Florida—Jacksonville, Jacksonville, FL, USA

    William Taylor Palfrey

  2. Internal Medicine, Department of Medicine, College of Medicine, University of Florida—Jacksonville, Jacksonville, FL, USA

    Peter Staiano & Kevin Green

  3. Department of Oral and Maxillofacial Surgery, College of Medicine, University of Florida—Jacksonville, Jacksonville, FL, USA

    Ashleigh Weyh & Salam O. Salman

  4. Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, College of Medicine, University of Florida—Jacksonville, Jacksonville, FL, USA

    Mariam Louis

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  1. William Taylor Palfrey
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  2. Peter Staiano
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  4. Ashleigh Weyh
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  5. Salam O. Salman
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Correspondence to Mariam Louis .

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Editors and Affiliations

  1. Oral and Maxillofacial Surgery, University of Florida – Jacksonville, Jacksonville, FL, USA

    Salam O. Salman

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Palfrey, W.T., Staiano, P., Green, K., Weyh, A., Salman, S.O., Louis, M. (2019). Medical Management of Obstructive Sleep Apnea. In: Salman, S.O. (eds) Modern Management of Obstructive Sleep Apnea. Springer, Cham. https://doi.org/10.1007/978-3-030-11443-5_2

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  • DOI: https://doi.org/10.1007/978-3-030-11443-5_2

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