RT Journal Article
SR Electronic
T1 How to treat patients that do not tolerate continuous positive airway pressure
JF Breathe
JO breathe
FD European Respiratory Society
SP 157
OP 167
DO 10.1183/20734735.020410
VO 7
IS 2
A1 O.M. Vanderveken
A1 A. Hoekema
YR 2010
UL http://breathe.ersjournals.com/content/7/2/157.abstract
AB Educational aims To outline recommendations concerning the proper management of obstructive sleep apnoea/hypopnoea syndrome (OSAHS) patients that cannot be treated adequately with continuous positive airway pressure (CPAP) due to intolerance, poor compliance or CPAP refusal. To provide information about the selection of appropriate patients for alternative non-CPAP treatment modalities. To better understand the different aspects of OSAHS treatment with oral appliances, including indications, contraindications, medical work-up and clinical protocol, and expected short- and long-term results. To discuss the different surgical options for the treatment of OSAHS and to provide information on the important issue of a proper patient selection for upper airway surgery, as most OSAHS surgical outcomes are associated with the pre-operative assessment of the level(s) of upper airway collapse. Finally, to present future perspectives in sleep apnoea surgery. Summary The effectiveness of continuous positive airway pressure (CPAP) is potentially high for the treatment of obstructive sleep apnoea/hypopnoea syndrome (OSAHS), but accounting for the relatively low acceptance and compliance, and correcting for sleep time, its actual effect and use, the adjusted CPAP effectiveness remains relatively low. Oral appliance therapy has emerged as a noninvasive alternative to CPAP in subjects with OSAHS who do not tolerate or comply with CPAP. Surgical procedures can be performed successfully in carefully selected patients. Moreover, concerning the surgical treatment options, it appears from the available evidence that maxillomandibular advancement is a safe and highly effective surgical treatment modality for OSAHS that should be indicated more readily in clinical practice. Two methods of pre-treatment airway evaluation will be discussed. First, newer technologies using imaging techniques coupled with computational fluid dynamics methods allow investigation of the flow characteristics and aerodynamic forces within the upper airway of the OSAHS patient. Secondly, routine application of drug-induced sleep endoscopy to assess the site(s) of flutter and upper airway obstruction during drug-induced sleep can increase the success rate of both upper airway surgery and oral appliance therapy.