Treatments for obstructive sleep apnea: CPAP and beyond

Abstract

Treatment options for obstructive sleep apnea include positive airway pressure and alternatives such as behavioral interventions, oral appliances, nasal expiratory positive airway pressure, negative pressure interventions, and surgical procedures. Certain drugs are also promising. An important aspect of the treatment includes troubleshooting the reasons for poor adherence to positive airway pressure treatment, discussing alternatives based either on individual preference or on phenotypic characterization of the sleep apnea, and managing expectations. KEY POINTSAs many as one-fourth of people age 30 to 70 may have obstructive sleep apnea, and the prevalence may be increasing.Patients should not expect continuous positive airway pressure (CPAP) therapy to help them lose weight. In fact, some patients gain weight on it.Bariatric surgery may fail to control obstructive sleep apnea in over 20% of patients and may be associated with lower CPAP adherence.Hypoglossal nerve stimulation is a newer surgical option for select patients who cannot use CPAP.