OSA Treatment Modalities

PAP Therapy

Positive Airway Pressure (PAP) devices are the first line treatment option recommended by the American Academy of Sleep Medicine (AASM) for OSA. Through the medium of a mask over the nasal, oral, or oronasal interface (nose, mouth or both), PAP devices create a pneumatic splint (air support) to open the upper airway that is prone to collapse during apneic events. PAP may be delivered in continuous (CPAP), bilevel (BiPAP), autotitrating (APAP) or adaptive servo ventilation (ASV) modes. PAP is the standard treatment recommended for moderate to severe OSA, and is a primary option for mild OSA.

Although PAP is the standard recommended clinical treatment modality for OSA (but not the only one), it requires proper introduction and education on the part of the Durable Medical Equipment (DME) provider, and an open mindset on the part of the patient. This is an extremely important dialogue, as PAP compliance statistics are generally poor, hovering at or just above 50%.
Evo Diagnostics highly recommends utilizing a reputable DME source for introduction to PAP. It is a well-known fact in the industry that compliance numbers can rise significantly with a proper introduction to a suitable interface. Nonetheless, the dialogue remains two-sided. If the patient's attitude has been skewed by irresponsible marketing of non-PAP commercial devices or social interactions that reflexively bias the individual against "sleeping with a mask", then PAP compliance will be an up-hill challenge. Based on the track record of PAP relative to some other forms of therapy for moderate to severe cases of OSA, we recommend that you give PAP a serious accommodation effort for the initial week after you have been prescribed the device if your physician has prescribed PAP. Once adapted, 76% of AASM survey respondents reported the quality of their sleep to be good to very good post treatment versus only 7% before (n=506). The same survey also disclosed that 41% of respondents were finally diagnosed with severe OSA and 43% were moderate even though the initial physician's assessment had 62% mild, 30% moderate and only 8% severe.
41%

BP Improvement

After PAP Treatment, 41% of AASM survey hypertensives had improvements in BP.

31%

HbA1c Improvement

After PAP Treatment, 31% of AASM survey diabetic patients had improved HbA1c numbers.

56%

Heart Disease Risk

After PAP Treatment, 56% of AASM survey heart disease candidates had decreased risk.

54%

Pulmonary Function

After PAP Treatment, 54% of survey asthmatics had improvements in pulmonary function.

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Other Treatments

Oral (Dental) Appliances: Oral appliances are an established treatment option for snoring and mild-to-moderate OSA. Oral appliances work by increasing the upper airway space. Appliances are designed to stabilize the anterior position of the mandible and/or to advance the tongue (or soft palate). Oral appliance therapy is generally well-tolerated, with short term side effects or minor discomfort.

Recently, the field of sleep medicine and sleep diagnostics have begun to recognize (through clinical studies) that oral appliances are an additional viable first line treatment to consider for mild to moderate sleep apnea in addition to CPAP.

AASM considers oral appliance therapy, in tandem with PAP, a first-line treatment option for patients with mild to moderate OSA, or patients that have tried and failed PAP therapy. Dental appliances are thus an important option for patients that have proved intolerant or non-compliant of CPAP therapy.
Surgical Management of OSA: OSA is potentially amenable to surgical intervention when specific anatomic features are present in the candidate. Three principle anatomic regions of potential collapse during sleep in patients with OSA include the nose, the palate, and the base of the tongue. Each region can be surgically restructured on its own or in combination when warranted. Soft tissue can be removed and the maxilla and mandible may be repositioned forward to expand the posterior airway space.

Weight-Loss: Weight-loss is considered an important adjunct treatment option for OSA. AASM has recently emphasized that over time PAP use may drop in favor of weight loss, but they also stress that weight-loss is not initially emphasized (as a primary option) by physicians. Weight-loss is effective for OSA, however, weight-management efforts do not retain a sustained track record when evaluated five-years past significant weight loss; although bariatric surgery fares better than commercial diet programs.

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