26 Aug Management of Obstructive Sleep Apnoea (OSA) in Adults
OSA severity is defined as:
- mild for respiratory disturbance index (RDI) ≥ 5 events/hour and < 15 events/hour
- moderate for RDI ≥ 15 events/hour and < 30 events/hour
- severe for RDI ≥ 30 events/hour
Continuous positive airway pressure titration can be performed during in-lab PSG or at home with autotitration. Autotitration is not recommended as a method for diagnosing OSA (Strong recommendation).
Weight reduction is recommended in all overweight and obese patients with OSA (Strong recommendation).
Continuous positive airway pressure (CPAP) is the treatment of choice for moderate-to-severe OSA as it has been shown to improve quality of life, reduce excessive daytime sleepiness, decrease motor vehicle accidents, and improve comorbid conditions such as heart failure or chronic obstructive pulmonary disease (Strong recommendation).
Oral appliances including mandibular advancement devices and tongue retaining devices are indicated for use in patients with mild-to-moderate OSA who prefer oral appliances to CPAP, are unresponsive to CPAP, are not candidates for CPAP, or who fail behavioural measures such as weight loss and repositioning (Strong recommendation).
Medications such as modafinil may improve daytime sleepiness and may be used in conjunction with CPAP therapy or mandibular advancement devices in selected cases but not as sole therapy for OSA.
Surgical procedures, such as uvulopalatopharyngoplasty, may be used to reshape or open up the airway in patients with mild OSA with surgically correctable severe obstructing anatomy, but the degree of benefit for clinical outcomes is unclear.
A follow-up polysomnography should be performed to assess the effectiveness of CPAP after substantial weight loss (for example, 10% of body weight) or if there is insufficient clinical response (Strong recommendation).
CPAP trial for diagnosis: AASM states autotitrating positive airway pressure (APAP) not recommended to diagnose OSA (AASM Guideline). APAP devices not intended for diagnostic purposes. APAP devices change treatment airway pressure based on feedback from measures such as airflow, pressure fluctuations, and airway resistance. Reference – AASM practice parameters for the use of autotitrating continuous positive airway pressure devices for titrating pressures and treating adult patients with obstructive sleep apnea syndrome (Sleep 2008 Jan;31(1):141 full-text).
DynaMed Plus [Internet]. Ipswich (MA): EBSCO Information Services. 1995 – . Record No. T115600, Obstructive sleep apnea (OSA) in adults; [updated 2018 Dec 04, Brisbane Australia 22/03/2019]. Available from: https://www.dynamed.com/topics/dmp~AN~T115600 .