New Apnea Guidelines Released
Thursday, January 15, 2015 04:11 PM

The first line of defense against obstructive sleep apnea should be weight loss, according to new guidelines from the American College of Physicians.  If more treatment is needed, the first choice should be continuous positive airway pressure (CPAP), but so-called mandibular advancement devices can be used as an alternative therapy, the guidelines suggest. 

On the other hand, there is insufficient evidence to say surgery has any benefit and, given its risks, it "should not be used as initial treatment,” and drug therapy has been tried, but evidence was insufficient to conclude that any of them worked. 

Obstructive sleep apnea is an increasing issue, "probably because of escalating obesity rates," the guidelines noted, so that more and more people are likely to seek treatment.  The first recommendation of the guideline committee was that all overweight and obese patients who have obstructive sleep apnea should be encouraged to lose weight.  The investigators concluded that the evidence showed that "some intensive weight-loss programs may effectively reduce signs and symptoms of (obstructive sleep apnea) in obese patients with or without diabetes."

But in cases where patients are not overweight or where weight-loss interventions fail, the next line of defense should be CPAP, which is the most intensely studied therapy, the committee argued.  The evidence shows that CPAP reduces daytime sleepiness, cuts the AHI and arousal index scores, and increases quality of life, although it has not been shown to improve the latter, they reported.

In patients who are unable or unwilling to use CPAP, mandibular advancement devices can be an alternative to CPAP, they said. The devices move the lower jaw forward slightly during sleep to tighten the soft tissues of the airway and prevent apnea. The committee noted that evidence shows the devices are better than no treatment in improving AHI scores, arousal index scores, and minimum oxygen saturation.  But the evidence also shows that CPAP does a better job, they found.