CPAP (continuous positive air pressure applied through a nasal mask) is considered the gold standard for treatment of obstructive sleep apnea (OSA). CPAP, when properly used, will control obstructive sleep apnea 100% of the time.
Sleep Position Training
In some patients, obstructive sleep apnea is related to sleeping on one's back. Positional therapy for the treatment of OSA has been studied. According to some researchers the prevalence of positional OSA is between 55 and 60%. Several devices have been developed to encourage the patient to sleep on his/her side rather than back.
- Weight reduction is occasionally the only treatment needed for the obese patient. Long term results require behavior modification to maintain reduced weight. (Neck size is a reliable index as a predictor of OSA. In men OSA is more prevalent in those with a neck size > 17 inches; in women, neck size > 15.5 inches.)
- Reduction in the intake of alcoholic beverages
- Limitations in the use of sedatives and muscle relaxants
- Cease smoking
At times, nasal congestion or obstruction can lead to problems with snoring and apnea. In cases where the nasal passage is obstructed such as with enlarged turbinates or nasal polyps, surgical intervention is often needed.
Because nasal CPAP is often poorly tolerated, a search for pharmacological treatment of sleep disordered breathing was instituted. Unfortunately, there is no universally accepted pharmacological treatment for OSA that will take the place of CPAP or oral appliance therapy.
The Pillar procedure consists of placing three polyester implants into the soft palate. These implants, in time, are intended to support and stiffen the soft palate which will reduce the tissue vibration causing snoring and prevent the collapse that can lead to obstructive sleep apnea.
Genioglossus tongue advancement
This surgical procedure is designed to improve the airway behind the base of the tongue. The genioglossus muscle (the main tongue muscle) relaxes during sleep often allowing the tongue to fall back into the airway.
The hyoid bone, located in the neck, is the attachment of some tongue muscles. If the hyoid bone is pulled forward, it can open the airway space behind the tongue.
Somnoplasty provides a relatively painless procedure to treat habitual snoring by reducing soft-palate tissue volume in a precise minimally invasive manner. Snoring has been shown to decrease following tissue volume reduction.
The UPPP is a surgical procedure in which the soft palate and uvula are removed. The procedure usually eliminates snoring but only has a 40% chance of lowering the apnea hypopnea index to acceptable levels. There is no way to predict surgical success.
In this procedure the upper and lower jaws are advanced anteriorly and fixed in a position that maximally increases the size of the airway.