Treatment of Sleep Apnoea

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Besides weight loss and sleep hygiene measures, the therapeutic backbone for treating Sleep Apnoea/Hypopnoea Syndrome (SAHS) is continuous positive airway pressure (CPAP).

Non-drug therapy

The non-drug treatment of SAHS can be divided into three key pillars:

Hygienic/dietary and postural measures. These measures form the initial treatment for patients with mild to moderate SAHS and no significant symptoms. Additionally, the following general recommendations are given to all patients with sleep apnoea:

Person sleeping in bed

Get enough sleep (8 hours) and follow a regular timetable.

Beer mug and joint crossed out; no drug consumption

Abstain from alcohol (primarily in the evenings) and smoking.

Scale with a down arrow indicating a weight loss

Obese patients should lose weight.

Nose drops

Treatment of any nasal obstructions.

Man running; regular physical exercise

Regular physical exercise (this can reduce the number of events by more than 30%). 

Drug crossed out

Suppression of central nervous system depressants (benzodiazepines, narcotics and barbiturates).

Person sleeping on the bed lying on the side

Patients with mild to moderate SAHS who predominantly sleep on their backs can avoid this position while asleep with the aid of a device that stops them from turning over.

Continuous positive airway pressure (CPAP). In patients with moderate or severe SAHS, or those with mild, but very symptomatic, SAHS, besides the general measures, recommendations are for the first-choice treatment with continuous positive airway pressure (CPAP).

Person sleeping with CPAP

A CPAP machine consists of a turbine that generates and drives an airflow through tubing that connects to a mask (nasal or nasal-buccal) fixed in place on the face with straps. The mask intentionally leaks some gas to avoid reinhalation. Thanks to the balance between the flow and rate of leakage from the mask, the system transfers pressurised air to the UAW which acts like a pneumatic wedge and stops the pharynx from collapsing while asleep, thus preventing apnoea and normalising the structure of sleep. Each patient requires a certain CPAP pressure, so the correct amount should be determined individually through a nighttime sleep study. There are various systems available to help set the correct CPAP level. CPAP is a safe, bloodless and reversible device. There are no absolute contraindications for the use of CPAP.

Intraoral devices. In select cases, patients with mild or moderate SAHS may benefit from mandibular advancement devices (MADs).

Person with Mandibular Advancement Device

These comprise splints that ease the jaw forwards and therefore increase the retropharyngeal space and prevent the jaw and tongue from falling backwards. MADs are particularly indicated in non-obese patients (BMI < 30) with predominantly positional apnoea (lying on back) and with mild/moderate apnoea.

Drug therapy

There are currently no drugs available with proven efficacy in the treatment of SAHS.

Treatment complications

Patients often experience mild side effects for the first few weeks while using CPAP. They are generally very mild, temporary and respond well to local measures, so patients should be monitored closely over the first few months. It is particularly important that individuals receive adequate training and education before starting to use CPAP.

Substantiated information by:

Cristina Embid
Josep M. Montserrat Canal
M Concepción Ruiz Sánchez

Published: 16 January 2020
Updated: 16 January 2020

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