Sleep apnea medical therapy
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Overview
If left untreated, sleep apnea can have serious and life threatening consequences: heart disease, hypertension, automobile accidents due to excessive daytime sleepiness, and many other ailments. Treatment often starts with behavioral therapy. Many patients are told to avoid alcohol, sleeping pills, and other sedatives, which can relax throat muscles, contributing to the collapse of the airway at night.[1]
Possibly owing to changes in pulmonary oxygen stores, sleeping on one's side (as opposed to on one's back) has been found to be helpful for central sleep apnea with Cheyne-Stokes respiration.[2]
Medical Treatment
Medications
Medications like acetazolamide[3][4] lower blood pH and encourage respiration. Low doses of oxygen are also used as a treatment for hypoxia but are discouraged due to side effects.[4][5][6]
Oral appliances
General dentists can fabricate an oral appliance. The oral appliance, called a mandibular advancement splint, is a custom-made mouthpiece that shifts the lower jaw forward and opens the bite slightly, which opens up the airway. Oral appliance therapy (OAT) is usually successful in patients with mild to moderate obstructive sleep apnea.[7] OAT is a relatively new treatment option for sleep apnea in the United States, but it is much more common in Canada and Europe.
Continuous positive airway pressure
For moderate to severe sleep apnea, the most common treatment is the use of a continuous positive airway pressure (CPAP) or automatic positive airway pressure (APAP) device,[1] which 'splints' the patient's airway open during sleep by means of a flow of pressurized air into the throat. The patient typically wears a plastic facial mask, which is connected by a flexible tube to a small bedside CPAP machine.[8] The CPAP machine generates the required air pressure to keep the patient's airways open during sleep. Advanced models may warm or humidify the air and monitor the patient's breathing to ensure proper treatment.
Although CPAP therapy is extremely effective in reducing apneas and less expensive than other treatments, some patients find it extremely uncomfortable. Many patients refuse to continue the therapy or fail to use their CPAP machines on a nightly basis, especially in the long term.[9] One way to ensure CPAP therapy remains comfortable and effective for patients is to carefully consider the right CPAP face mask to be used. CPAP masks come in different shapes, sizes and materials to ensure effective treatment for obstructive sleep apnea. It is important to select the right mask to fit each patient.
It is not clear that CPAP reduces hypertension or cardiovascular events in patients who do not have daytime sleepiness; however, the lack of benefit may be partly due to noncompliance with therapy.[10]
References
- ↑ 1.0 1.1 "How Is Sleep Apnea Treated?". National Heart, Lung, and Blood Institute.
- ↑ Szollosi I, Roebuck T, Thompson B, Naughton MT (2006). "Lateral sleeping position reduces severity of central sleep apnea / Cheyne-Stokes respiration". Sleep. 29 (8): 1045–51. PMID pmid16944673 Check
|pmid=value (help). - ↑ White DP, Zwillich CW, Pickett CK, Douglas NJ, Findley LJ, Weil JV (1982). "Central sleep apnea: Improvement with acetazolamide therapy". Archives of Internal Medicine. 142 (10): 1816–9. doi:10.1001/archinte.142.10.1816. PMID 6812522. Unknown parameter
|month=ignored (help) - ↑ 4.0 4.1 "Sleep Apnea". Diagnosis Dictionary. Psychology Today.
- ↑ Mayos M, Hernández Plaza L, Farré A, Mota S, Sanchis J (2001). "[The effect of nocturnal oxygen therapy in patients with sleep apnea syndrome and chronic airflow limitation]". Archivos de Bronconeumología (in Spanish). 37 (2): 65–8. PMID 11181239. Unknown parameter
|month=ignored (help) - ↑ Breitenbücher A, Keller-Wossidlo H, Keller R (1989). "[Transtracheal oxygen therapy in obstructive sleep apnea syndrome]". Schweizerische Medizinische Wochenschrift (in German). 119 (46): 1638–41. PMID 2609134. Unknown parameter
|month=ignored (help) - ↑ Machado MA, Juliano L, Taga M, de Carvalho LB, do Prado LB, do Prado GF (2007). "Titratable mandibular repositioner appliances for obstructive sleep apnea syndrome: are they an option?". Sleep & Breathing. 11 (4): 225–31. doi:10.1007/s11325-007-0109-y. PMID 17440760. Unknown parameter
|month=ignored (help) - ↑ General Information about Sleep Apnea Machines
- ↑ Hsu AA, Lo C (2003). "Continuous positive airway pressure therapy in sleep apnoea". Respirology. 8 (4): 447–54. doi:10.1046/j.1440-1843.2003.00494.x. PMID 14708553. Unknown parameter
|month=ignored (help) - ↑ Barbé F, Durán-Cantolla J, Sánchez-de-la-Torre M; et al. (2012). "Effect of continuous positive airway pressure on the incidence of hypertension and cardiovascular events in nonsleepy patients with obstructive sleep apnea: a randomized controlled trial". JAMA. 307 (20): 2161–8. doi:10.1001/jama.2012.4366. PMID 22618923. Unknown parameter
|month=ignored (help)
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