Sleep apnea secondary prevention
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Saarah T. Alkhairy, M.D.
Overview
Secondary prevention of sleep apnea involves lifestyle changes, continuous positive airway pressure (CPAP), placement of an oral device. These methods reduce the severity of sleep apnea on the patient.
Sleep Apnea Secondary Prevention
Lifestyle Changes
- Weight loss
- Reduce alcohol
- Reduce sedative use
- Smoking cessation
- 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.[1]
- Optimize treatments that may exacerbate sleep apnea e.g. asthma, allergic rhinitis
- Assess risk for hypertension, diabetes cardiovascular disease, cerebrovascular disease, or renal disease
Continuous positive airway pressure
- For moderate to severe sleep apnea, CPAP therapy is extremely effective in reducing apneas and less expensive than other treatments
- It '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[2]
- The CPAP machine generates the required air pressure to keep the patient's airways open during sleep
- Many patients refuse to continue the therapy or fail to use their CPAP machines on a nightly basis because they find it uncomfortable[3]
- One way to ensure CPAP therapy remains comfortable for patients is to ensure the CPAP face mask fits well
- 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[4]
Oral appliances
- Mandibular Advancement Splint
- A oral appliance placed by general dentists
- 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[5]
- OAT is a relatively new treatment option for sleep apnea in the United States, but it is much more common in Canada and Europe
Alternative Therapies
- Strengthening the muscles around the upper airway may combat sleep apnea
- A 2009 study published in the American Journal of Respiratory and Clinical Care Medicine found that patients who practiced a series of tongue and throat exercises for 30 minutes a day showed a decline in sleep apnea symptoms after three months. Patients experienced an average of 39% fewer apnea episodes after successfully completing the treatments.[6]
- A 2001 study investigated changes after Tongue Muscle Training (ZMT®) in respiratory parameters during night-time sleep of patients with increased respiratory disease index. The apnea, hypopnea and desaturation indexes were reduced in 26 of the 40 patients (65%) by an average of approximately one half.[7]
References
- ↑ 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). - ↑ 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) - ↑ 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) - ↑ Guimarães KC, Drager LF, Genta PR, Marcondes BF, Lorenzi-Filho G (2009). "Effects of oropharyngeal exercises on patients with moderate obstructive sleep apnea syndrome". Am. J. Respir. Crit. Care Med. 179 (10): 962–6. doi:10.1164/rccm.200806-981OC. PMID 19234106. Unknown parameter
|month=ignored (help) - ↑ Gessmann HW et al: The Tongue Muscle Training (ZMT®) in nCPAP Patients with Obstructive Sleep Apnea Syndrome (OSAS). PIB Publisher Duisburg, Germany 2001