Treating OSA: Current and emerging therapies beyond CPAP

Abstract

Continuous positive airway pressure (CPAP) is the standard treatment for moderate-to-severe obstructive sleep apnoea (OSA). However, adherence to CPAP is limited and non-CPAP therapies are frequently explored. Oral appliance (OA) therapy is currently widely used for the treatment of snoring, mild, moderate and severe OSA. The most commonly used and studied OA consists of a maxillary and mandibular splint which hold the lower jaw forward during sleep. The efficacy of OA is inferior to CPAP; however, the effectiveness as measured by sleepiness, quality of life, endothelial function and blood pressure is similar likely due to higher acceptance and subjective adherence. Upper airway stimulation augments neural drive by unilaterally stimulating the hypoglossal nerve. The Stimulation Therapy for Apnea Reduction (STAR) study enrolled 126 patients and demonstrated a 68% reduction in OSA severity. A high upfront cost and variable response are the main limitations. Oropharyngeal exercises consist of a set of isometric and isotonic exercises involving the tongue, soft palate and lateral pharyngeal wall. The collective reported trials (n = 120) showed that oropharyngeal exercises can ameliorate OSA and snoring (~30-40%). Nasal EPAP devices consist of disposable one-way resister valve. A systematic review (n = 345) showed that nasal EPAP reduced OSA severity by 53%. The Winx device consists of a mouthpiece placed inside the oral cavity that is connected by tubing to a console that generates negative pressure. Winx may provide successful therapy for~30-40% of OSA patients. In conclusion, several non-CPAP therapies to treat OSA are currently available.

Recognizing Poor Sleep Quality Factors During Oral Health Evaluations

“…57 For patients who are suspected to have moderate or severe sleep apnea, a polysomnography is often recommended. 17 This method requires the individual to go to a sleep center or hospital to be observed during the sleep process. 17 Sensors are placed in specified locations on a patient's head, neck, and chest to record brain activity, muscle tone, and eye movements during the various phases of sleep.…”

“…16,25 A surgical procedure alone does not necessarily restore normal nasal breathing during sleep; 16,25 however, in some cases, tonsil removal along with oral myofunctional therapy has been shown to produce more positive results in achieving improved sleep quality. 16,17 Oral myofunctional therapy, which consists of specific exercises to strengthen and retrain the tongue, soft palate, and pharyngeal walls, may be an effective adjunct in OSA therapy and was shown to reduce the apnea-hypopnea index by 30%-40% in adults. 17 Exercises to strengthen the muscles of the face and improve tongue placement in the oral cavity can contribute to a decrease in snoring, improvement in daytime sleepiness, improvement in polysomnography results, and improved blood oxygen saturation.…”

“…16,17 Oral myofunctional therapy, which consists of specific exercises to strengthen and retrain the tongue, soft palate, and pharyngeal walls, may be an effective adjunct in OSA therapy and was shown to reduce the apnea-hypopnea index by 30%-40% in adults. 17 Exercises to strengthen the muscles of the face and improve tongue placement in the oral cavity can contribute to a decrease in snoring, improvement in daytime sleepiness, improvement in polysomnography results, and improved blood oxygen saturation. 17 Treatment of OSA often includes the use of a CPAP device, which forces air through a face mask or nasal cannula worn on the patient's face to keep the airway open during sleep.…”

“…15 Oral health professionals are in the optimal position to detect a sleep quality concern due to the oral presentation of individuals suffering from chronic poor sleep issues. 16,17 When poor sleep is suspected, it is the responsibility of oral health clinicians to refer patients to an appropriate allied health professional. 18,19 The American Dental Association has adopted a formal policy statement that states dentists are to include screening for sleep-related breathing disorders during all oral examinations.…”

Year in review 2017: Interstitial lung disease, pulmonary vascular disease and sleep

“…Acceptance and long‐term adherence to CPAP are suboptimal despite being highly efficacious. Various non‐CPAP options are available, although the clinical responses to these are mixed and not easily predictable . Phenotyping an individual aids in determining whether a therapy is likely to be effective and opens the way for developing newer targeted therapies .…”