Obstructive sleep apnoea syndrome and its management

Abstract

Obstructive sleep apnoea (OSA) is a common disorder characterized by repetitive episodes of nocturnal breathing cessation due to upper airway collapse. OSA causes severe symptoms, such as excessive daytime somnolence, and is associated with a significant cardiovascular morbidity and mortality. Different treatment options are now available for an effective management of this disease. After more than three decades from its first use, continuous positive airway pressure (CPAP) is still recognized as the gold standard treatment. Nasal CPAP (nCPAP) is highly effective in controlling symptoms, improving quality of life and reducing the clinical sequelae of sleep apnoea. Other positive airway pressure modalities are available for patients intolerant to CPAP or requiring high levels of positive pressure. Mandibular advancement devices, particularly if custom made, are effective in mild to moderate OSA and provide a viable alternative for patients intolerant to CPAP therapy. The role of surgery remains controversial. Uvulopalatopharyngoplasty is a well established procedure and can be considered when treatment with CPAP has failed, whereas maxillar-mandibular surgery can be suggested to patients with a craniofacial malformation. A number of minimally invasive procedures to treat snoring are currently under evaluation. Weight loss improves symptoms and morbidity in all patients with obesity and bariatric surgery is an option in severe obesity. A multidisciplinary approach is necessary for an accurate management of the disease.

Keywords: continuous positive airway pressure; obstructive sleep apnoea; oral appliance; positional therapy; uvulopalatopharyngoplasty.

Figure 1.

Polygraphic recording of an obstructive apnoea. Interruption of nasal airflow in the presence of thoracic and abdominal movements. Below, oscillations of oxygen saturation (SaO₂).

Figure 2.

Survival curves (unadjusted Kaplan–Meier) by obstructive sleep apnoea severity as expressed by the apnoea hypopnoea index (AHI). The numbers at risk are presented above the x axis. From the study by Kendzerska et al. [2014].

Figure 3.

Indications for the management of obstructive sleep apnoea based on the apnoea hypopnoea index (AHI). Continuous positive airway pressure (CPAP) should be considered as the first choice of treatment, whereas positional treatment is indicated only when positional apnoeas have been documented.

Figure 4.

Treatment options for obstructive sleep apnoea. Reproduced with kind permission of Bloch [2006].