Advancements in Sleep Apnea Treatments: A Brief Overview

Advancements in Sleep Apnea Treatments

By Admin

The treatment of obstructive and central sleep apnea has come a long way since tracheotomies were used in the more severe cases in the 1970s, and though CPAP remains the leading treatment option for apnea and hypopnea events, there are now a number of alternatives with varying results depending on the specific needs of a patient’s condition, preferences, and overall health. Below is a brief overview of some of the more common options available, along with recommendations for those interested in pursuing the treatments further.

Weight Loss and Lifestyle Changes

To begin, doctors often recommend a change of lifestyle in order to improve the overall health of the patient and treat whatever underlying conditions may be provoking the symptoms. This often begins with exercise and changes in diet, as well as a change of evening routines to reverse any habits that may contribute to the problem. Quitting smoking, reducing caffeine or alcohol intake during late hours, and refraining from over-the-counter sleeping pills to mask the symptoms can all have a considerable positive effect on the disorder. But these recommendations are made regardless of other treatment options explored. Although weight is not always a factor in sleep apnea diagnoses, excess weight and obesity are by far the most common causes of obstructive sleep apnea in adults. Even just a 10 percent reduction in body weight can reduce the number of apnea or hypopnea events for most patients (Sleep Review).

Positional Therapy

In addition to other lifestyle changes, there are some patients who benefit from sleeping on their sides, rather than on their backs. In these patients, breathing pauses occur only when they sleep on their backs. Thus, the use of pillows or other props can help reduce or even eliminate the apnea events. There are now devices available that aid in this process by vibrating when the patient turns over during the night. Positional therapy, also known as Supine Avoidance Therapy, is normally a first-line treatment used for patients with mild to moderate sleep apnea, and though it can reduce the overall AHI, its effect on snoring is variable. For patients with a more elevated supine apnea index, snoring may actually increase with positional therapy because the apneas are then replaced with snoring. In addition, some studies show poor long-term compliance with positional therapy due to the inability of patients to adapt to the change.

Oral Appliance Therapy (OAT)

Oral appliances are becoming more and more popular due to their ease of use and low cost, but they remain works in progress, often adopted by those who are unable to use CPAP after multiple attempts. Some options include tongue stabilizing devices (TSD) or tongue titrating/retaining devices, consisting of a splint that holds the tongue in place to keep the airway open, nose breathe appliances for heavy snoring, and the most common oral appliances for apnea, mandibular advancement devices (MADs), which resemble the mouth guard used in sports. While oral appliances do not have the treatment success rates of CPAP therapy, their greatest selling point is their compliance rate, which in some cases is as high as 80%. While oral devices can be extremely convenient and easy to use, there are some potential drawback. A clinical practice guideline published jointly in 2015 by the American Academy of Sleep Medicine (AASM) and American Academy of Dental Sleep Medicine (AADSM) recommends oral appliance therapy exclusively for patients who are intolerant of CPAP therapy or other treatments. Since CPAP is more effective than oral appliance therapy in improving AHI and lowering both the arousal index and the oxygen desaturation index (ODI), the literature suggests that physicians reserve oral appliance prescriptions for those patients with adherence issues. Other issues of concern for oral appliances include the movement of teeth and altered bites, a potential for pain or irritation as a result, dry lips or mouth, and arthritis of the temporomandibular joint (TMJ).

Expiratory Positive Airway Pressure (EPAP)

EPAP, known by the brand name Provent, utilizes sleep apnea therapy disposables that attach externally to each nostril, pressurizing the airway to keep it open. Like oral appliances, EPAP has a treatment success rate of about 50%, but compliance rates are high. Patients with severe breathing disorders, low blood pressure, or those with acute upper respiratory infections should not use EPAP, as there is high potential for aggravation of existing conditions due to fluctuations in breathing patterns. As with oral appliances, current research is looking into the overall effectiveness of the therapy.

Oral Pressure Therapy (OPT)

Oral Pressure Therapy such as the Winx Sleep Therapy System delivers a gentle vacuum through a soft flexible mouthpiece, which helps to keep the airway open by cushioning the tongue and soft palate from falling back into the airway, very similar to CPAP itself. Users of this form of therapy must be able to breathe comfortably through their nose with their mouth closed. While the cushioning of the tongue will not address every patient’s sleep apnea in the same way, it is effective for those with consistent tongue and palate blockage issues. Oral pressure therapy is still quite new, and should not be used to treat central sleep apnea or any severe respiratory disorder, such as severe lung disease, pneumothorax, etc; has loose teeth or advanced periodontal disease.

Surgical Procedures

Surgical procedures for sleep apnea have advanced more than any other treatment in the last three decades. Beginning with uvulopalatopharyngoplasty (UPPP), the standard surgical procedure for sleep apnea in which the surgeon removes soft tissue from the back of the throat, procedures have progressed with the use of laser assistance, radiofrequency volumetric tissue reductions (RFVTR), and further adaptability for those with less accommodating anatomy. Other procedures include maxillomandibular advancement, also called jaw repositioning, anterior inferior mandibular osteotomy, which divides the chin bone into two parts, allowing the tongue to move forward, Genioglossus advancement, which involves the tightening of the tendons in the front of the tongue to keep it from rolling back, glossectomy and tongue reductions, and bariatric surgeries for weight loss issues, among others. Some newer surgical treatments involve electrodes attached to the hypoglossal nerve that controls the tongue. The electrode is connected to a device similar to a pacemaker. When you stop breathing in your sleep, the device stimulates your tongue muscles to prevent them from blocking your airway. This is a newer treatment option with promising results. However, one review of the procedure noted that its results are less consistent in people with a higher body mass index. The Pillar Procedure is another new technique that uses a permanent suture to stiffen and stabilize the palate, reducing airway vibration and collapse. This is a good option for those with a significant palatal component to their snoring and/or sleep apnea profiles. Like any implant, the body must accept and accommodate the new material, and there is some risk of resistance or rejection by the body systems.

Inspire Upper Airway Stimulation (inspiresleep.com)

Another surgical implant for sleep apnea is Inspire Upper Airway Stimulation (UAS). A procedure with growing popularity in the sleep apnea community, Inspire therapy is an implanted system that senses breathing patterns and delivers mild stimulation to important airway muscles that keep the airway open during sleep. Inspire therapy is even controlled with a small handheld remote. All surgical procedures need to be tailored to a patient’s specific anatomy and condition, such as the amount of obstruction in the upper airway, and these considerations are a major component of the decision to pursue a surgical treatment. While these many procedures have shown to be effective in reducing or eliminating obstructive sleep apnea at success rates at or above 50%, there are of course considerable precautions to be addressed before opting for such a permanent measure. Anyone considering these procedures should have several consultations with a experienced physician before opting for a treatment of choice.

And Back to CPAP

For Positive Airway Pressure Therapy, the advances have continued to make the treatment option a first-rate choice for physicians and patients alike. While it is good to have so many options available for those who are unable to use CPAP, or simply cannot adjust to it, the use of positive airway pressure devices remains the gold standard on several levels of advancement, including the masks themselves, which have become minimally obtrusive, lighter, and more comfortable. The machines have become virtually soundproof, easily programmable, and with wireless capabilities can send data to a provider or doctor’s office at any time, allowing for easily accessible patient profiles. Choice of treatment depends on a number of factors, including the severity of your problem, your overall health, and the physical structure of your airway, as well as your own personal habits and preferences. But a professional’s educated opinion should always be the first step in seeking a proper treatment.